Financial Counselor

Job Summary

Responsible for counseling patients regarding their insurance benefits; with accountability for collecting and/or establishing financial payment arrangements to adhere to LMC policy regarding the financial responsibility according to insurance carrier and/or self-pay obligations in order to have a positive financial impact on the practice. Interprets and applies compliance guidelines to maintain billing integrity.
 

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 6 months insurance experience in a healthcare setting
Substitutable Education & Experience: None.
Required Certifications/Licensure: None.
Required Training: Procedural knowledge of commercial, Medicaid, Medicare, Workers' Compensation, all  contractual third party payers, other private carriers, billing, reimbursement, and regulatory  compliance; Extensive knowledge of medical terminology, HCFA 1500, ICD10, and CPT coding.
 

Essential Functions

• Works independently but closely with manager and operations director or division administrator.
• Assist patient with benefit coordination to assure the appropriate financial obligation and responsibility is met in a timely manner.
• Identify potential billing issues and act to resolve those problems quickly, and work collaboratively with physicians and managers regarding effectiveness in reimbursement rates, billing and collection.
• Expectation is to stay current on all Governmental Reimbursement programs in order to provide assistance and guidance to leadership on reimbursement-related matters within the LMC contractual agreements.
• Accurately prepare financial payment statements outlining benefits and collect appropriate funds and/or establish payment arrangements prior to date of surgery to maintain A/R days within set goals, as required.
• Obtain and verify appropriate documentation from payor to establish coordination for clean claims.
• Communicates with the CBO to assist as appropriate in the writing of appeals for denied claims and follow up on claims processing.
• Assist CBO staff with accounts and reviews invoices for accuracy and completeness as deemed appropriate.
• As requested, calculate estimates for visits, procedures, and/or surgeries, electronically managing records of estimates provided.
• Verifies accuracy and correct use of ICD10 and CPT coding.
• Compliance with carrier’s policies.

Duties & Responsibilities

• Post patient payments and assist with posting insurance payments, as deemed appropriate.
• Research and follow-up on denials, claim corrections and rejections, as requested.
• Provides accurate interpretation of EOBs, bulletins, advisories, fee schedules, payor guidelines, regulations and all other pertinent information.
• Provides education to all office staff regarding financial counseling.
• Assists patient, office staff, and insurance companies regarding claims, payments, adjustments, referrals and pre-certifications.
• Maintains all informational material received from insurance companies, documenting all information within account notes.
• Responsible for maintaining billing integrity: Fraudulent or abusive billing practices, (i.e., duplicate billing, overstating charges, etc.). Any exceptions should be brought to the immediate attention of the manager.
• Demonstrates knowledge of commercial, Medicaid, Medicare, Workers’ Compensation, all contractual third party payors and other private carriers.
• Prepares and runs reports on a daily, weekly, monthly basis or as deemed appropriate.
• Helps maintain the work area in a neat and orderly fashion. Responsible for keeping supplies needed to perform the job duties.
• Demonstrates appropriate communication of information to all ages and responds to all customers/ patients requests and needs, i.e., hard of hearing, etc.
• Respond to customer inquiries, complaints and correspondence in a prompt and professional manner to conform to LMC’s Service Excellence guidelines and LMC’s corporate compliance.
• Performs all other duties as assigned.