Lead Financial Counselor-MSHAR

UMass Memorial Health; Marlborough (MA); On-site; USD 27,000 - 44,000; Full time

Benefits offered by this job

Signing bonus possible

Job summary

UMass Memorial Health is seeking a Lead Financial Counselor (CAC) to oversee a team providing care coverage needs assessment for patients and families. You will guide enrollment in Health Connector, MassHealth, and related programs, ensuring accurate paperwork and timely submission.

Applicants should have 3 years in healthcare billing/financial counseling, a CAC, and an associate degree. The role emphasizes collaboration with clinics, social workers, and community partners to help patients

Qualifications

• 3 years' experience in healthcare, accounts receivable, Financial Counseling, medical billing, or related field.
• Proficient in department collection practices and third party/bad debt regulations.
• Excellent written and verbal communication skills to interact with patients, hospital staff and external partners.

Responsibilities

• Distribute and monitor work flow for a team of Financial Counselors.
• Prioritize work in a high-volume, fast-paced environment.
• Assist patients with health coverage eligibility using CMS guidelines and state programs.
• Explain eligibility rules and enrollment options for MassHealth, Health Connector, Medicaid managed care, and Health Safety Net.
• Coordinate with clinical and community partners to ensure access to care and timely discharge planning.
• Provide price estimates to patients in line with price transparency regulations.
• Maintain accuracy in EPIC queues and patient records.

Skills

Communication skills

Problem solving

Independent worker

English fluency

Education

Associates Degree in Business or Social Services

CAC certification

Tools

EPIC

Health Connector/MassHealth knowledge

Job description

Exemption Status: Non-Exempt

Hiring Range: $19.53 - $32.06

(based on a full time schedule of 40 hours per week).

Please note that the final offer will vary based on scheduled hours. Compensation for part-time or reduced schedules will be prorated based on scheduled weekly hours, experience, skills, qualifications, and internal equity considerations.

Schedule Details: Monday through Friday

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

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

Hours: 40

Cost Center: 10021 - 5640 Patient Accounting

Union: SHARE Marlborough

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 Lead Financial Counselor (Certified Application Counselor) provides functional oversight to an assigned group of Financial Counselors for the process of providing health care coverage needs assessment with patients, community applicants, and family members.

Major Responsibilities

• 1. Responsible for distributing and monitoring the flow of work for an assigned group of Financial Counselors.
• 2. Prioritizes work in high volume, fast paced, team-oriented environment.
• 3. 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.
• 4. 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.
• 5. Interacts with patients, the community, and outside agencies in a professional manner in keeping with the Mission and Vision of UMMHC.
• 6. 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.
• 7. 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.
• 8. 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.
• 9. 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.
• 10. 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.
• 11. Provides and documents price estimates request to patients in accordance with federal price transparency regulations.
• 12. 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.
• 13. 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.
• 14. Discusses financial obligations with patients prior to elective surgical days or admissions. Communicates all information to provider offices and other Revenue Cycle departments.
• 15. Updates all accounts to reflect the current account status with appropriate financial class, eligibility dates, other patient financial and demographic information.

Standard Staffing Level Responsibilities

• 1. Distributes and monitors the flow of work for an assigned group of employees. Provides training and technical assistance to employees within the assigned work area. Assists supervisor in assuring that assigned employees are provided with appropriate resources, materials, and methods. Provides recommendations to manager or supervisor for the most efficient utilization of assigned personnel. Relays work instruction from the supervisor. Provides direction, guidance and leadership in the absence of the supervisor.
• 2. Complies with established departmental policies, procedures and objectives.
• 3. Attends variety of meetings, conferences, seminars as required or directed.
• 4. Demonstrates use of Quality Improvement in daily operations.
• 5. Complies with all health and safety regulations and requirements.
• 6. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• 7. Maintains, regular, reliable, and predictable attendance.
• 8. Performs other similar and related duties as required or directed.
• All responsibilities are essential job functions.

Position Qualifications

License/Certification/Education

Required:

• 1. Associates Degree in Business, Social Services or three years' experience in healthcare, accounts receivable or related function.
• 2. Certified Application Counselor (CAC)certification.
• 3. Completes annual recertification and all mandatory ongoing training provided by the Massachusetts on-line Learning Management System and complies with privacy and security regulations that meet all federal program standards.

Experience/Skills

Required:

• 1. 3 years' experience in healthcare, accounts receivable, Financial Counseling, medical billing, or a related field.
• 2. Proficient in department collection practices and concepts of third party, bad debt and free care regulations.
• 3. Excellent written and verbal communication skills in order to communicate effectively with a variety of levels including patients, hospital, and medical staff.
• 4. Effective communication and customer service skills both verbal and written.
• 5. Ability to use specialized applications software and computers systems for patient registration and scheduling.
• 6. Ability to work independently with strong problem resolution skills.
• 7. English speaking, reading and writing skills

Preferred:

• 1. Bilingual speaking, reading.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

Physical Demands and Environmental Conditions

Work is considered light with frequent walking throughout the day. Must be able to cover at other campuses if warranted. Must provide own transportation. Position requires work indoors in a normal office and/or patient care environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [e-mail]. We will make every effort to respond to your request for disability assistance as soon as possible.