CHOP EMPLOYEE? SEARCH FOR JOBS HERE.
Philadelphia, PA, US, 19104
Location: LOC_HOME-Home/Remote Office Location
Req ID: 146581
Employment Status: Regular - Full Time
This is a position requiring professional phone skills, independent thinking, and advanced insurance/registration techniques. The Financial Counselor will be responsible for verification of insurance, detailed benefit collection and authorization processes for patients seeking care at CHOP. The Financial Counselor will handle verification of insurance, detailed benefit collection, and identification of covered and non-covered services, explanations of benefits structures, as well as necessary contact families, providers, and payors regarding: referral issues, authorizations, FHCC eligibility as well as a host of other insurance eligibility and authorizations of services issues. The Financial Counselor will cross cover other areas as needed.
Demonstrates an understanding and provides information of benefit structures to patients, physicians, and hospital practices as well as provides information on the following areas:
Hospital prompt pay and payment plan policies
Process for pre-cert/pre-auth of non covered services
Provider ID numbers & CPT codes (if applicable)
Verify coverage & benefit information via electronic eligibility or by contacting payor and documenting relevant information in Epic
Follows up with insurance companies and families of patients identified as ineligible or non- covered
Follows up with insurance companies and families of patients identified as ineligible or non-covered
Contacts family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party. Contact clinical office with all information that requires follow-up.
Assist with FHCC issues and Completes abbreviated assessment to determine family eligibility for Family Health Care Coverage programs.
Educates families and clinical team regarding insurance coverage plans.
Review diagnosis/procedure codes to ensure they are documented correctly and accurately reflect the clinical information and services to be performed.
Discuss and send pertinent medical history to complete authorization process.
Discuss, interpret and send pertinent medical history to complete authorization process (inclusive of pre-determinations).
Work on complex medical cases that are in pending status until cases are complete and works with clinical teams for additional clinical information and/or a letter of medical necessity
Notify physician office/hospital of coverage issues, denials due to procedures not medically necessary, or if insurance carrier requires additional clinical information and/or peer to peer requests.
Prioritize daily requests based on date of service, insurance carrier requirements, unexpected date changes or urgent requests, while processing request within department standards.
Stay abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy.
Coordinates denials, complete retrospective review as needed, and inform physician office of denial.
Refer self-pay patients to business office for payment options.
Ability to convert common diagnosis descriptions to numeric ICD 9 or CPT code.
Creates templates with correct CPT Codes for specific services for Single Case Agreement
Update patient registration as needed, specifically demographics and insurance information
Ensure specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payor plan entries for research and standard-of-care visits
Verify coverage through payor portals and pull appropriate referrals as needed.
Coordinate & communicate insurance issues with appropriate personnel (e.g. schedulers)
Educate and inform family of outstanding financial obligations if appropriate.
Electronically collect or facilitate payment of outstanding balances as needed
Required Education and Experience
Required Education: High School/GED
Preferred Education, Experience & Cert/Lic
Preferred Education: Associate's Degree
EPIC registration experience
Resource scheduling experience (i.e. ancillary testing)
Background in medical terminology
Additional Technical Requirements
Medical Insurance background
Strong customer service experience
Ability to work with stressful situations
Ability to function efficiently and professionally with minimum of supervision.
Ability to quickly learn new procedures.
Strong computer skills.
Ability to juggle multiple insurance issues.
Strong customer service skills
Ability to display compassion and empathy
Mandatory required training within first 30 days:
ACD Software Training
Website Insurance Training (Navinet, WebMD, Passport)
EPIC training & testing (Prelude/Cadence).
Cardiac Center databases
All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.
Children's Hospital of Philadelphia is committed to providing a safe and healthy environment for its patients, family members, visitors and employees. In an effort to achieve this goal, employment at Children's Hospital of Philadelphia, other than for positions with regularly scheduled hours in New Jersey, is contingent upon an attestation that the job applicant does not use tobacco products.
Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.
VEVRAA Federal Contractor/Seeking priority referrals for protected veterans. Please contact our hiring official with any referrals or questions.
CHOP Careers Contact
2716 South Street, 6th Floor
Philadelphia, PA 19146
CHOP EMPLOYEE? SEARCH FOR JOBS HERE.
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Children's Hospital Of Philadelphia