Insurance Verifier and Financial Counselor

Summary:
Reports directly to the Patient Access Supervisor, the Insurance Verifier/Financial Counselor has multiple responsibilities including but not limited to: for independently resolving any inpatient insurance verification and financial clearance issue prior to and after an appointment as well as for financially screening non-sponsored patients for potential linkage and/or payment arrangements. The insurance clearance may include insurance eligibility, benefits verification, payer plan code assignment, referral coordination and financial clearance while Financial Counseling may include assessing various payors such as Medicaid, Indian Health Services, COBRA, Disability programs, Charity programs, payment plans, and/or other sources of sponsorship. Insurance Verification involves contacting patients and insurance/third party payers to resolve eligibility and benefits issues and to initiate insurance appeals if necessary and is responsible for communicating with practice managers, clinicians, staff and patients to ensure that visits are appropriately registered, and meet all insurance billing requirements. It is expected this person will notify the appropriate practice manager when patient accounts are at financial risk and to recommend options that will sustain the Hospital while ensuring financial reimbursement. Financial Counseling assists patients and/or their families with Medicaid and/or other sponsorship applications. The Financial Counselor also counsels patients and/or their families regarding financial liability to the hospital

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days

Education:
Essential:
* High School Diploma or GED

Responsibilities:
*Ensures monitoring of non-sponsored patients, including accounts referred from the Insurance Verification Unit and other clinical areas within the Hospital
*Assesses all new accounts under his/her assignment. Performs financial screening in accordance with the financial screening guidelines
*Appropriately screens and verifies benefits for any inpatient account where sponsorship is identified before referring to the Insurance Verification Unit
*Secures sponsorship post-discharge for any accounts not screened while in house. Completes necessary follow-up on accounts that have discharged. Contact the patient via phone, email and/or mail until necessary documentation is obtained and application is submitted
*Interviews non-sponsored patients for incomplete financial and demographic information, and obtaining compliance-related documents and signatures as needed
*Proactively follows-up with the Department of Human Services and other eligibility offices until a decision regarding patient eligibility has been made
*Documents patient information clearly and completely in Epic according to the Documentation Standards. Reviews outcome of financial screening and immediately documents the determination from the interview and any needed follow-up action
*Refers self-pay patients to vendor(s) appropriately. Ensures due diligence is complete before referrals are made
*Attends Financial Counseling Unit meetings. Reviews updated and new procedures, reviews team goals, and contributes in identifying training needs/barriers
*Uses standardized procedures that emphasize assertive steps to resolve and gain reimbursement for all accounts in the Financial Counseling Unit. Seeks guidance from supervisor when feedback is needed regarding introduction of new processes or strategies in handling accounts
*Secures sponsorship for patients, including payment arrangements, government programs, third party liability, and insurance verification. Keeps current on PHS financial policies, including payment plans, programs, and other forms of funding
*Assists qualified patients with applications for Medicaid, Institutional Medicaid, disability programs, charity programs, and other sponsorship programs
*Communicates patient s estimated financial liability. Works with patient and/or patient s family to establish payment plan if patient will not qualify for any form of sponsorship
*Coordinates all aspects of securing accounts to include pre-registration, eligibility and benefits, referral coordination, and expressing financial expectations using on-line systems, telephonic verification, and faxing to update and verify patient demographic and payer information.
*Documents and updates all registration and financial data in the Hospital Information System. Responsible for the correct identification and selection of appropriate insurance plan codes.
Performs follow-up functions to correct deficiencies in data collection utilizing available systems such as ONTRAC*, the Hospital Information System and ancillary systems as available.
*Obtains complete demographic and billing data collection from non-English speaking patients by arranging for Interpreting Services or other assistance as may be necessary to facilitate the completion of registration and financial clearance process.
*Responds to telephone inquiries related to registration practices, billing and insurance requirements and general services provided in different programs and locations. Assumes responsibility for routing calls to appropriate individuals and departments.
*Develops strategies to be effective and remain professional while coping with difficult customers and situations. Maintain awareness of cultural, socio-economic, individual, religious, gender and other diversity uniqueness in patient s communication.
*Establishes communication with patient access staff to inform them to contact patients and possibly reschedule appointments. Notifies the appropriate Ambulatory Care practice/physician s office about cancellations and requests rescheduled appointments based on patient s medical needs and physician decision for patients who are not eligible for services or not authorized.
*Advises supervisor/manager of problems and potential problems as soon as possible within 24 hours. Takes ownership of all appointments assigned. Personal actions demonstrate accountability for the outcomes of the unit.
*Works closely with supervisors, practice managers, physicians, and all members of the health system to resolve problems or issues related to patient s registration, financial issues or third party payer inquiries.
*Follows work prioritization standards as established, using standard tools (ONTRAC* worklists, reports, etc.) to complete work in the most effective manner established, and enter appropriate account status codes. Documents work activity clearly, concisely, and completely all in a timely manner according to established documentation standards.
*Assists in training of new and additional personnel and provides for coverage as needed.
*Applies skills, knowledge, abilities, and utilizes reporting tools in order to meet performance and productivity standards as defined by workloads.
*Adheres to department Quality Review process. Performs extensive follow-up as accounts are processed to ensure timely and accurate completion. Adheres to department productivity expectations as outlined.

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.