Financial Counselor-SHARE

UMass Memorial Medical Group; Worcester (MA); On-site; USD 31,000 - 44,000; Full time

Benefits offered by this job

Signing bonus

Job summary

UMass Memorial Medical Group in Worcester, MA seeks a Financial Counselor (Non-Exempt) to assess patient eligibility for MassHealth, Health Connector and related programs. You will guide patients through enrollment, gather financial information, and coordinate with clinics and external agencies to ensure access to care.

The role involves heavy interaction with patients, families and staff, and requires accuracy in documentation and adherence to state and federal guidelines.

Qualifications

• Interviews, screens and assess applicants and family members in a variety of on campus locations.
• Determines qualification for affordable health insurance coverage including APCTC, premium assistance, and other programs.
• Acts as liaison for patients with MassHealth and related health coverage programs.

Responsibilities

• Interviews, screens and assess applicants and family members in a variety of on campus locations utilizing income and household composition and other criteria in accordance with CMS and other governmental established guidelines for program eligibility.
• Determines qualification for affordable health insurance coverage, including the application of advance premium tax credits (APTC), premium assistance programs, Medicare Savings Plans and any other program they may be determined eligible.
• Interacts with patients, the community, and outside agencies in a professional manner in keeping with the Mission and Vision of UMMHC.
• Facilitates enrollment through the online Health Connector Health Insurance Exchange (HIX) or any other program application by accurate and timely submission of necessary paperwork according to state and federal regulations and policies.
• Follows up with patients in person or by telephone to obtains appropriate confidential financial and medical information on incomplete applications.to establish eligibility for various financial assistance programs.
• Acts as the liaison for patients with MassHealth, the Health Connector and the Health Safety Net to assist in the resolution of eligibility discrepancies, applications status updates, and any other issue that may arise in the determination process.
• Facilitates patient understanding of health access options including but not limited to eligibility rules, coverage types, enrollment periods, products and plans available through MassHealth, the Health Connector, Medicaid Managed Care, and the Health Safety Net program.
• Responsible for coverage of the Financial Counseling call center to act as a resource for patients and families, members of the community, clinical departments and other Revenue Cycle departments with insurance coverage issues and questions.
• Provides and documents price estimates request to patients in accordance with federal price transparency regulations.
• Works within EPIC work queues to identify and reach out to uninsured/underinsured patients/families (inpatient, outpatient, surgical day, psychiatric in patients, psychiatric outpatients, etc.) for the purpose of screening for assistance programs and upgrades to a richer benefit program.
• Works in conjunction with clinical areas, interpreters, social workers, case managers, social security outreach workers, drug assistance coordinator, enhanced benefit coordinator, care mobile, physician/provider offices and community health centers as needed to ensure access to care and timely discharge planning.
• Discusses financial obligations with patients prior to elective surgical days or admissions. Communicates all information to provider offices and other Revenue Cycle departments.
• Updates all accounts to reflect the current account status with appropriate financial class, eligibility dates, other patient financial and demographic information.

Tools

EPIC

Job description

Exemption Status

Non-Exempt

Hiring Range

$22.29 - $32.04 (based on a full time schedule of 40 hours per week).

Schedule Details

Monday through Friday

Scheduled Hours: 8:00 AM - 4:30PM

Shift: 1 - Day Shift, 8 Hours (United States of America)

Hours: 40

Cost Center: 99940 - 5480 Financial Counseling

Union: SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Under the general direction of the Financial Counseling Supervisor/Manager and/or Financial Clearance Director, the Financial Counselor (Certified Application Counselor) provides a key role in providing a health care coverage needs assessment with patients, community applicants, and family members. Determines eligibility for MassHealth, Qualified Health Plans, Children's Health Insurance, Health Safety net and any other coverage that they may qualify. Provides guidance and assistance to patients, various internal UMass staff, physician offices and third-party vendors regarding financial assistance programs.

Major Responsibilities

• 1. Interviews, screens and assess applicants and family members in a variety of on campus locations utilizing income and household composition and other criteria in accordance with CMS and other governmental established guidelines for program eligibility.
• 2. Determines qualification for affordable health insurance coverage, including the application of advance premium tax credits (APTC), premium assistance programs, Medicare Savings Plans and any other program they may be determined eligible.
• 3. Interacts with patients, the community, and outside agencies in a professional manner in keeping with the Mission and Vision of UMMHC.
• 4. Facilitates enrollment through the online Health Connector Health Insurance Exchange (HIX) or any other program application by accurate and timely submission of necessary paperwork according to state and federal regulations and policies.
• 5. Follows up with patients in person or by telephone to obtains appropriate confidential financial and medical information on incomplete applications.to establish eligibility for various financial assistance programs.
• 6. Acts as the liaison for patients with MassHealth, the Health Connector and the Health Safety Net to assist in the resolution of eligibility discrepancies, applications status updates, and any other issue that may arise in the determination process.
• 7. Facilitates patient understanding of health access options including but not limited to eligibility rules, coverage types, enrollment periods, products and plans available through MassHealth, the Health Connector, Medicaid Managed Care, and the Health Safety Net program.
• 8. Responsible for coverage of the Financial Counseling call center to act as a resource for patients and families, members of the community, clinical departments and other Revenue Cycle departments with insurance coverage issues and questions.
• 9. Provides and documents price estimates request to patients in accordance with federal price transparency regulations.
• 10. Works within EPIC work queues to identify and reach out to uninsured/underinsured patients/families (inpatient, outpatient, surgical day, psychiatric in patients, psychiatric outpatients, etc.) for the purpose of screening for assistance programs and upgrades to a richer benefit program.
• 11. Works in conjunction with clinical areas, interpreters, social workers, case managers, social security outreach workers, drug assistance coordinator, enhanced benefit coordinator, care mobile, physician/provider offices and community health centers as needed to ensure access to care and timely discharge planning.
• 12. Discusses financial obligations with patients prior to elective surgical days or admissions. Communicates all information to provider offices and other Revenue Cycle departments.
• 13. Updates all accounts to reflect the current account status with appropriate financial class, eligibility dates, other patient financial and demographic information.

Standard Staffing Level Responsib