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Under the direct supervision of the Manager Financial Counseling & Self Pay Receivables, the Financial Counselor is responsible for assisting patients, patient families or caregivers with verifying and/or reviewing private and public health insurance plan coverage to determine available benefits. Identifies patient eligibility for public assistance or other financial assistance, and assists patients with establishing payment arrangements. Financial counseling may be performed in many areas including, but not limited to the emergency department, admitting, outpatient and physician practices.
- Interviews patients for the purpose of explaining financial obligations and establishing appropriate method of resolution in accordance with policy. Ensures patients have been medically screened and stabilized prior to interview.
- Identifies and assists uninsured or under-insured patients. Provides financial screening eligibility criteria, communication tools and patient resources information related to financial assistance and other community programs. Estimates patient liabilities.
- Refers patients to available funding sources such as Medicaid, Access to Care, and Medicare and determines eligibility for financial assistance programs designed to provide free or discounted care to eligible patients. Assists with completion of financial assistance forms.
- Develops and maintains a collaborative relationship with physicians, nursing staff, registration staff, patient financial services, social work staff, community resources and contracted eligibility vendor staff to ensure timely assistance to patients.
- Requests payment in accordance with established policies. Accepts and accurately posts payments in accordance with policies and procedures.
- Negotiates payment arrangements using independent judgment and in accordance with established procedures for patients who are unable to pay in full prior to or at time of service.
- Posts payment plan terms/correspondence/account adjustments in appropriate billing system utilizing electronic payor eligibility tools.
- Verifies patient account information and insurance coverage for accuracy. Ensures all necessary documentation is on file. Utilizes electronic or telephonic resources.
- Assists with development of Medicare Secondary Payor (MSP) information.
- Responds to inquiries from registration clerks in collection of co-pays when difficulties arise in accordance with established procedures.
- Works with patients to resolve all outstanding balances through established procedures. Responds to patient's questions regarding billing and balances.
- Follows hospital (or system) and department policies and procedures with special attention to attendance and punctuality, confidentiality, dress code and display of ID badge, and safety.
- Other duties as assigned
Education:
- EDUCATION: High School Diploma or GED. Note: An Associate'sDegree in Accounting, Finance, or other related field may substitute for up to one year of the stated experience OR a Bachelor's Degree in Accounting, Finance, or related field may substitute for up to two years of stated experience.
Certifications:
- LICENSURE/CERTIFICATION/REGISTRATION: None required.
Complexity of Work:
- COMPLEXITY OF WORK: Requires critical thinking skills decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Work Experience:
- REQUIRED EXPERIENCE: Minimum four years previous experience in collection or other related experience with a bank, finance company or in a health care institution. Experience processing medical insurance claims is helpful.
Physical Requirements:
- PHYSICAL REQUIREMENTS: Normal physical demands include dexterity sufficient to operate CRT/PC and other office equipment. Requires the ability to sit and be stationary for prolonged periods of time, normal or corrected vision and manual dexterity sufficient to perform work on a personal computer.
Personal Protective Equipment:
- Follows standard precautions using personal protective equipment as required
- PERSONAL PROTECTIVE EQUIPMENT: Follows standard precautions using personal protective equipment as required.
Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities