The Financial Counselor is responsible for patient financial counseling to include verifying of benefits and eligibility on admission inquiries, Auditing and scanning patient information, collecting co-pays, coins, and deductibles from patients, assisting with establishing effective and timely payment plans, coordinating with utilization review and discharge planning efforts to limit risk of non-payment, providing ongoing patient benefit information, participating in patient discharge procedures, and coordinating financial arrangements with collection personnel; assisting with AHCCCS HEA-Plus applications for approval.
Upon receipt of an intake inquiry form, verifies eligibility and benefits for all admissions.
Communicate benefits information and co-payments to patients and families prior to admission.
Obtain after-hours admission files from the Intake department each morning.
Maintain ticker filing system for authorizations and benefit expiration; and communicate on a daily basis with the CFO and morning Flash Meeting, when necessary.
Ensure all pre-admission and admission calls and paperwork are addressed and completed in an accurate and timely manner:
a.Contact the appropriate agencies to obtain treatment authorization numbers, reimbursement structure, and patient eligibility.
b.Conduct a financial interview with the patient, family, guarantor or responsible party prior to admission based on insurance verification. Calculate the amount of deposit necessary and collect the deposit or make arrangements for payment.
c.Verify current employment, recent previous employment, dates of hire & termination for each and insurance information.
d.Complete the telephone profile of insurance benefits in a timely fashion.
e. Ensure that all admission forms are completed accurately and appropriate signatures are obtained.
f.Assign the correct financial class and adjust financial class as required.
g.Notify the appropriate facility management of any potential problems related to admission or payment.
h. Obtain a deposit and explain benefits and financial obligations within 48 hours of admittance,with all exceptions approved by the CFO.
i. Complete a demographic pre-certification required.
6. Complete the admission folder within one working day of admission, scan the documents into the assigned shared folder and schedule all critical dates for appropriate follow up.
a.Provide admission folder to the appropriate facility management for review within one working day of admission.
b.Ensure written confirmation of benefits and eligibility is sent to the primary and secondary insurance carrier, and scheduled for follow up.
7. Provide financial counseling to patient and/or guardian or assigned responsible party:
a.Contact patient or assigned contact within 48 hours to make payment arrangements and to obtain deposits if not done prior to admission, with all exceptions approved by the CFO. Obtain copy of missing insurance cards and picture IDs.
b.Serve as a patient liaison between the family or assigned parties, and business office case management staff.
c.Obtain the financial worksheet and income proof, as required, prior to discharge.
d.Complete timely and effective payment arrangements and verify/confirm patient demographic information prior to or upon discharge whenever possible.
e.Participate in completing appropriate paperwork for patient discharge, and coordinate patient financial arrangements
8. Maintain all in-house accounts in a current and accurate manner:
a. Review all in-house accounts and clearly documents the status of the file regarding all financial and legal issues. Complete all required information.
b.Clearly document all activity occurring during the admission as it pertains to eligibility, benefits, reimbursement, financial counseling and required signatures.
9. Coordinate with other departments within the facility to assure appropriate usage of
a.Coordinate with the utilization management staff to determine benefits for reduced level of care (i.e. day care, outpatient).
b.Coordinate with ase management staff and physicians/licensed practitioners for treatment extensions when appropriate, as well as coordinating coverage limits and other length of stay issues for patients.
10. Provide back-up support to the receptionist/switchboard as required.
11. Adhere to facility, department, corporate, personnel and standard policies and procedures.
12. Attend all mandatory facility in-services and staff development activities as scheduled.