Facility: Spalding Medical Center

Job Summary:

The PAS Financial Counselor III represents the Hospital in financial matters pertaining to obtaining payment on patient accounts during pre-admission, inpatient, and outpatient phases of the patient's visit. Acts as intermediary with Admitting, Business Office, patients, and family members while the patient is hospitalized.

Coordinates full patient financial counseling, education & referrals, employs and completes all patient liability collection escalations through proper collection of all estimated patient liabilities, including co-payments and unmet deductibles before, during and after time of service. Verifies insurance benefits and coverage for inpatients and outpatients. Responds to customer requests and answers questions regarding various service and account information. Analyzes and rectifies customer concerns using established procedures. Uses computer to access and/or update customer records.

Verifies and posts transactions. Follows established procedures for processing receipts, cash etc. Sorts and files various documents. Assists with general hospital information and directions to departments within and outside of the WHS facility. Establishes financial arrangements to reduce financial risk for WHS, helping to ensure that WellStar is reimbursed for its services.

Responsible for promptly and efficiently responding to patient inquiries regarding charges and account settlement. Information is collected and responded to via phone or in writing for email and written letters.

Working knowledge of the rules and regulations pertaining to government programs

Core Responsibilities and Essential Functions:

Quality/ Safety

• Reviews daily census and visits hospital patients when appropriate, verifies patient coverage, benefits, and collects estimated patient liable amounts.

• Interviews each patient or representatives to obtain complete and accurate demographic, financial and insurance information.

• Obtains all necessary signatures and is knowledgeable regarding any special forms that may be required by the patients third party payer.

• View charges to determine financial estimates and collects appropriate co-pays/ and or deductibles.

• Makes corrections and updates patient account information in computer.

• Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes.

• Maintains a working knowledge of available information system capabilities and performs all system applications that are required.

• Understands and applies WHS philosophy and objectives, and PAS policies and procedures, as related to assigned duties. Understands the admission, outpatient and emergency registration process.

• Maintains confidentiality of patient information, in accordance with WHS policy and HIPPA regulations.

• Consistently demonstrates the ability to organize work recognizes and establishes appropriate work priorities, and completes work in a productive manner, without creating backlogs.

• Maintains proficiency in data entry skills.

• Assists with Medicaid screening on all accounts.

• Resolves error in Patient WorkQueues

Budget/Financial

• Attempts to collect the estimated self-pay balance of all inpatient, outpatient and ER accounts, at the earliest possible collection control point.

• Monitors in-house accounts and attempts to make financial arrangements with guarantors for payment of their self-pay balances in full, prior to discharge, or within ten working days thereafter.

• Communicates with Medicaid Eligibility team and applicable vendor(s) to determine eligibility and approval/ denial status, as needed.

• Completes financial evaluation forms to document guarantors' income, expenses, assets and liabilities.

• Identifies those patients without adequate insurance coverage. Makes personal contact with patient or guarantor to determine guarantor's ability to pay non-covered charges, as well as to determine potential eligibility for financial assistance programs (namely Medicaid).

• Maintains a list of health care financial assistance programs and the eligibility requirements for each program. Refers patients/guarantors to sources of outside funding assistance, distributes financial assistance (i.e. Medicaid) applications as need.

• Works efficiently and accurately within designated time frames to ensure a continuity of information and cash flow.

• Interviews all inpatients and select (self-pay) outpatients at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information, explain financial policies, and collect the estimated self-pay balance.

• Documents concise and understandable notes regarding all self-pay account collection activity, as well as each patient or guarantor interaction. Documents all efforts to collect patient account balances, other self-pay collection activities and referrals to Medicaid.

• Coordinates financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services.

• Verifies insurance coverage and benefits.

• Exceeds monthly quota on a consistent basis. Formally reports results of self-pay collection activity to direct supervisor, on a daily basis or according to policy. Provides feedback to PAS management concerning self-pay collection and data integrity issues.

• Responsible for completion of appropriate error/issues in WorkQueues.

Customer Service

• Greets all guest with a positive and professional attitude.

• Answers incoming phone calls and follows through with requests made.

• Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the general public. Demonstrates ability to tactfully handle difficult situations.

• Presents a well-groomed and professional image in coordination with department/ hospital dress codes.

• Provides appropriate telephone etiquette and scripting.

• Must be flexible with work hours to meet department needs.

• Meets service recovery and customer service guidelines.

• Keep current & convey knowledge of various insurance plans to customers as needed.

• Works well with Staff and understands appropriate department process.

• Identify & Request additional info as needed to complete authorization requests.

• Expected Performance, Behaviors and Results:

• The WellStar Experience (Must demonstrate a commitment to Service Excellence by):

• Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members.

• Valuing patients and family members as partners in their care.

• Having world-class processes in place.

• Delivering high-touch care that is reliable, responsive and coordinated.

• Focusing on constant innovation and creating improvements.

• Celebrating our diversity with sensitivity and understanding.

• Embracing the idea that we are all owners of our health system.

General

• Observes work hours and provides proper notice of absences, tardiness work schedule changes.

• Cross-trained in all areas of registration.

• Attends select departmental meetings at the request of WHS Management.

• Completes annual mandatory training as required.

• Maintain several Login IDs & expertise in various insurance pre-certification and authorization processes.

• Performs other duties as assigned.

PAS Financial Counseling are Level III team members and as such serve as preceptors and mentors therefore must:

• Maintain a based on individual QA audit /or as reported by Epic (min. of 10 accounts) registration accuracy rate or higher in the past 12 months.

• Maintain minimum productivity requirements.

• Has no corrective disciplinary action during the past twelve (12) months.

• Willing and able to function as a preceptor in the orientation of new patient access personnel and students.

• Maintain required certifications by obtaining necessary CEUs and submitting timely to certifying board.

• Performs other duties as assigned

• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• High school diploma or GED Required

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• Cert Healthcare Access Associate within 120 Days or Certified Patient Account Rep within 120 Days or Certified Revenue Cycle Rep within 120 Days

Required Minimum Experience:

• Minimum 1 year healthcare experience in Patient Access Services, Practice Operations, or Patient Financial Services. Bachelors degree or higher may substitute for experience Required

• Minimum 2 years related experience in a healthcare setting. At least one year in a healthcare setting performing financial counseling or functions consistent with preservice operations including healthcare collections. Preferred

Required Minimum Skills:

• Effective communication skills (both written and verbal) with the ability to communicate with various members of the healthcare team.

• High attention to detail

• self-directed and a positive attitude are essential.

• Effective problem solving and critical thinking skills.

• Typing or data entry competency of at least 40 words/minute.

• Cash handling and balancing.

• Demonstrated professionalism

• Working knowledge of patient registration systems and intermediate Microsoft Office Suite are preferred. Epic experience preferred.

• Knowledge of medical terminology, CPT codes, HCPCS & ICD-10 codes. Detail understanding and interpretation of Explanation of Benefits (EOBs).

• Mandatory completion of: Patient Access Services (PAS) Operations Onboarding Training followed by a minimum passing score of on final exam within 45 days of hire. Staff who do not pass will no longer meet the minimum requirement and will subsequently have the option to meet with the Talent Acquisition Specialist to assess other positions available within the health system.

• PAS employees who successfully complete the PAS onboarding exam will have the option to progress through enrollment to the WHS Enterprise Membership - HFMA Certification program, subject to PAS leadership approval.