Job description
WE ARE INSIGHT:
At Insight Hospital and Medical Center Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now!
GENERAL SUMMARY:
At Insight Hospital and Medical Center Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now!
GENERAL SUMMARY:
Under the leadership of the Patient Access Director/Manager, The Financial Counselor is responsible for meeting with patients/guarantors, who require assistance in seeking and applying for healthcare funding (i.e. Charity Care, Medicaid or other local/governmental funding programs) and/or require assistance in reviewing and establishing payment options. The Financial Counselor is responsible for a broad spectrum of duties: ensuring that patients are educated on their financial obligations and insurance benefits, providing resources to secure coverage via state/federal programs and managing the patient’s account until discharge. The Financial Counselor is responsible for working with patients to ensure that the hospital receives maximum payment for all services rendered, while assisting the patient with all avenues of financial assistance available, in addition to performing cashiering and customer service functions.
These duties are to be performed in a highly confidential manner, in accordance with the mission, values and behaviors of Mercy Hospital and Medical Center. Employees are further expected to provide a high quality of care, service, and kindness toward all patients, staff, physicians, volunteers and guests.
Duties and Responsibilities:
- Seeks appropriate funding based upon patient requirements, collecting supporting documentation (payroll stubs, tax returns, credit history, etc.), as required. Provides information and education to the patient, family member and/or guarantor regarding the application/documentation process. In so doing, the incumbent will encourage patient participation in the funding process and will assist the patient in forwarding the required documentation and application to the appropriate funding agency.
- Counsels patient/guarantor on patient’s financial liability, third-party payer requirements and outside financial resources, including Private Organizations and Foundations, eligibility vendor(s), Medicaid, Medicare, Tricare, and/or federal disability programs, etc.
- Counsels patient/guarantor of payment plan options and establishes appropriate payment plans
- Assists patient/guarantor in completing applications for applicable funding sources, financial statement and/or payment contract when required according to hospital policies. Analyzes such applications along with income/residential documentation in order to advise the patient of available options. Initiates requests for charity write-off, when applicable
- Analyzes financial and eligibility data, and length of disability to determine potential eligibility for federal, state, and/or county programs, completing the necessary documents within the time limits specified by the appropriate government agency
- Determines and manages proper course of action for optimal reimbursement of healthcare charges (e.g., spend down eligibility, out-of-network, Cobra coverage, etc.)
- Informs patient/guarantor of flat-rate/discount programs and assists patient with the application process, ensuring that adjustments are requested and processed
- Follows-up on eligibility applicants' status and review accounts in MANG pending status.
- Performs financial counseling on uninsured and underinsured patients for pre-service, time-of-service and post service basis.
- Interviews patient and/or their representative either via telephone or in-house to accurately update demographic information, financial and insurance data necessary to complete the financial counseling process.
- Responsible for the financial review of all inpatients who have no insurance or poor insurance coverage to ensure the patient’s maximum medical benefits are determined as early as possible.
- Reviews prior account notes for any information that might aid in the application/payment process, as well as documenting all encounters and actions.
- Makes financial arrangements and setup payment plans within Mercy’s established guidelines.
- Performs activities that relate to financial counseling for multiple patient types (Inpatient Admissions, Observation and Bedded Outpatients, Diagnostic Outpatients, Ambulatory Surgery, Series accounts, etc.).
- Review Self-pay Inpatients and Newborn accounts on a daily basis
- Communications with patients, family members and guarantors, third party payers, local/governmental agencies, attorneys, employers, physicians/office staff and contracted vendors/agencies.
- Internal contacts including the Pre-Certification Department, Inpatient Verification, Patient Access, Social Services, Utilization Review/ Case Management, Ancillary and Patient Care Services Nursing department staff.
- Informs patient/guarantor of their liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances.
- Calculate patient liabilities, conduct credit scoring and propensity to pay modeling in order to determine the patient/guarantor’s ability and propensity to pay for services.
- In the collection of funds, the incumbent posts payments/documents actions in the STAR patient accounting system and provides the patient with a payment receipt.
- Provides pricing estimates and communicates pre-service patient liability based on expected charges and potential coverage, as requested.
- Exhibit exceptional customer service and communication skills to effectively communicate with physicians, physician staff and patient/guarantor.
- Provides customer service functions such as responding to patient inquiries
- Serves as on-site resource for walk-in patients requesting assistance: understanding current or prior bills, difficulty paying their bills and updating missing or incomplete insurance information on prior accounts
- Generating itemized bill(s) and submitting refund request.
- Manages and monitors accounts in the pending eligibility financial class; follows-up on eligibility applications status, reviews accounts in MANG pending status and provides appeal assistance as needed and rebill Medicaid MANG pending accounts upon approval.
- Perform cashier duties as assigned
- Receive, post and balance payments
- Prepare bank deposits daily
- Totals money received and verifies totals with cash on hand
- Reconciles totals when errors are found
- Prepares report of daily transaction and document on shared drive
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
- High school diploma required or equivalent. Associate’s Degree or equivalent combination of education and/or work related experience. Previous work experience of at least two (2) years within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling and/or financial clearance. Knowledge of general insurance guidelines and regulations.
- Excellent verbal and written communication skills. Strong interpersonal skills are required in handling internal and external customers. General computer literacy and knowledge Proficient of Microsoft Office applications. Strong customer service skills with the ability to effectively communicate with physicians, physician’s office staff and patients.
- A strong, detail oriented mindset and good analytical skills. Must possess proficiency in medical terminology and insurance terminology. Ability to adjust quickly to changes in workflow and prioritize effectively. Ability to work effectively as a member of a multidisciplinary team. Ability to serve as a mentor for new staff as directed.
Insight Employees are required to be vaccinated for COVID-19 as a condition of employment, subject to accommodation for medical or sincerely held religious beliefs.
Insight is an equal opportunity employer and values workplace diversity!
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