Job Title: Financial Counseling Representative | Patient Access Management | Multi-City
Department : PATIENT ACCESS MANAGEMENT
Job Schedule: Full Time
Hours Per Shift: 8 hr
The Financial Counseling Representative provides financial counseling to assist patients in understanding their financial responsibility to Sanford and to offer appropriate resources and options to meet that responsibility. Answers billing questions.
Reviews patients insurance coverage and Explanation of Benefits (EOBs). Provides clarification regarding what charges were incurred and why they were incurred. Reviews insurance denials and provides an explanation for the denial to the patient. Reviews payment plan guidelines and assists in setting up payment arrangements.
Determines if patient is eligible for payment assistance programs and assists in the application process, if applicable. Educates patients regarding insurance concepts, such as what copayments are, what services are covered, effective dates of coverage, when a referral is needed and the effect on insurance, how to obtain a valid referral and resubmit the claim, and how effective dates of coverage influence insurance payments. May assist patient in filling out medical assistance program paperwork, as well as referrals to Medicaid or other insurance aid or disability programs.
Frequently advises uninsured patients on outstanding medical costs associated with procedures performed in a clinic setting and establishes a payment plan. Interacts with patients in-person and must be able to empathize with them while also diffusing strong emotions. Calculates and provides cost estimates for medical procedures, including the patients anticipated share.
Advises on and collects prepayments for services not covered by insurance. May perform guest service duties, as needed. Other duties as assigned.
Computer skills sufficient to operate on-line systems and complex software with advanced functionality. Oral and written communication skills sufficient to interpret and apply policies and procedures for clarification and problem resolution. Knowledge of third party payers and basic bookkeeping or accounting principles is required. Requires a thorough understanding of insurance products and the ability to accurately read an EOB to determine what adjustments have been made, what payments have been received, and calculate pending balances.
Receives incoming calls, screen calls and answers inquires on patient registration, billing, insurance verification, etc. Explain policies, procedures, or services to patients using medical or administrative knowledge.
Reviews medical bills for accuracy and appropriateness. Consults on securing medical records from providers and authorizing complex treatments. Audits and repairs financial coding to maximize reimbursement and enhance patient billing accuracy.
Delivers written and oral communication, responds to questions and concerns, and produce specific outcomes and impact. Develops trust and credibility by acting in a consistent, genuine manner. Establishes and maintains productive working relationships within and outside of own area.
Provides a quality of service that customers describe as excellent. Implements tactics to de-escalate problem situations immediately.
May notify appropriate insurance companies when patients have checked in for inpatient services and procedures requiring observation periods. This is included but not limited submitting notification online, through fax, or over the phone.
Reviews and validates insurance eligibility for planned/scheduled procedures and unplanned admissions. Benefit investigation on multiple types of insurance benefits for other hospital departments to include; SNF/Rehab, Transplant, and Behavioral Health. Knowledge of different types of insurances, admission policies, Medicaid referrals.
Ability to work from computer; must be comfortable with phone work. Collaborates with case management, social work, utilization management, and other cross-functional teams across the enterprise. Assists with the design and management of data including the preparation of reports and presentations.
Requires knowledge of and proficiency in the use of computers. To conduct full-cycle financial clearance functions for upcoming services including insurance verification, calculation of an estimate of charges, determination of patient liability, communication of financial responsibility to patients/guarantors and collection of payment or creation of payment arrangements. Assess financial assistance eligibility, explain application procedure and forward necessary paperwork and documentation to patients/guarantors. Verify patient insurance coverage, including identification and application of 3rd party benefits.
Position is full-time, day hours. Will be filled in either Sioux Falls, Fargo, or Bismarck market.
High school diploma or GED required; post-secondary education preferred. Two years' experience in healthcare service or health insurance preferred.
About Sanford Health:
At Sanford Health, we are dedicated to the work of health and healing.
Every day, we show that commitment by delivering the highest quality of care to the communities we serve.
We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth.
We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.
We continuously seek new ways to achieve our vision of improving the human condition here in your community,
across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities.
We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to request an accommodation for help with your online application,
please call 1-877-673-0854 or send an email to email@example.com .
In compliance with federal law requiring employers to verify new employees' U.S.
employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .
Job Function: Revenue Cycle
Job Schedule: Full Time
Req Number: req24826