Patient Financial Counselor – Self Pay| Full-Time

JOB SUMMARY:

The Patient Account Representative III – Self Pay (PAR III), under supervision of the Business Office Manager, will be responsible for collections of patient accounts both uninsured self-pay accounts, and self -pay after insurance is processed. This includes certain administrative functions when an account is at collections and recovered for Medicare Bad Debt logging. The PAR III-Self Pay assesses financial circumstances and assists with access to various LUHD financial assistance programs. This includes but is not limited to: completion of forms, explanation of policies and processes, and filing requirements including presumptive Medicaid assistance. The PAR III – Self Pay will assist in answering questions or concern patients may have regarding billing and payment expectations or transfer to Billing/Patient Accounting if appropriate. The PAR III – Self Pay will have knowledge of all aspects of the department from registration to billing and collection or otherwise know which area to seek assistance from.

ESSENTIAL DUTIES:

1. Maintains compliance with all HIPAA requirements.
2. Answers incoming telephone calls and returns voicemails daily.
3. Calculates and collects payments from patients in person and on the phone.
4. Thoroughly and timely works accounts in work queues as defined by policies and procedures.

• FC MDC Pending
• FC Accident Dx & Self Pay
• FC Expiring Application
• FC FA Under Review
• FC In-House Self-Pay
• FC Needs Info letter
• FC Adjustment needed
• Pre-Bad Debt Accounts
• No future collection events
• SP unapplied events

5. Demonstrates the ability to analyze patient account information for patient account issue resolution. Has exceptional knowledge of insurance benefits and standard medical billing protocols used to determine a patient’s financial responsibility.
6. Determines a patient’s active insurance coverage by using all available resources to accurately record and update information in the patient’s account, and updates claims to file to the correct insurance carrier.
7. Communicates with Billing/Patient Accounting in order to help resolve issues, as appropriate. Notifies billing staff of any re-billing, charge adjustments, refunding or collection intervention that needs to occur.
8. Processes statements including review, folding, stuffing statements accurately, include forms for payment plan and financial assistance.
9. Review returned mail. Contact patient for updated address or send to collections.
10. Set up arrangements/ monthly installment plans for patients to payoff balances within the guidelines of District collection policy.
11. Applies appropriate adjustments for:

• Community uninsured
• Prompt pay
• Financial Assistance
• Process other negotiated discounts

12. Assesses patient’s insurance benefits for individual that are uninsured and underinsured to determine whether the patient may be eligible for financial assistance or community uninsured discounts.
13. Maintains complete records of all patients applying for indigent or financial assistance. Assists with applications, collecting proof of income, and any other applicable documentation.

• Follows up on partially completed applications.
• Reviews completed financial assistance applications and determines approval.

14. Maintains a knowledge base of programs offered by LUHD such that assistance in applications, processing or contact to outside agencies is readily offered:

• Presumptive eligibility/ Certified OHP assist
• Financial Assistance Program including Charity
• Access One
• Western Mercantile Collection Agency
• Evolve Payment Plans (older accounts)
• Oregon Coast Billing Service Payment Plans
• Offer assistance with out-of-pocket costs through programs offered by pharmaceutical companies and other available means.
• Any additional programs that may be added in the future

15. Provides price estimate for future services and creates a payment plan to resolve older debt.
16. Process bad debt and OCB claims daily.

• Reconciliation of claims-confirming they received all accounts.

17. Process and logs quarterly Medicare Bad Debt.
18. No Surprises Act – CMS requirements.

• Provide good faith estimate in advance of scheduled services, or upon request.
• No balance billing for out-of-network emergency services.
• No balance billing for non-emergency services by nonparticipating providers at certain participating health care facilities, unless notice and consent was given in some circumstances.
• Disclose patient protections against balance billing.

19. Monthly Agency Reports Reconciliation – (accounts sent, returned, collections, adjustments, etc.)

• Evolve
• GCS
• OCB
• Western Mercantile

20. Other duties as required or assigned.

QUALIFICATION REQUIREMENTS:

Education and License:

High School Diploma or equivalent, required.

Medical Terminology knowledge, preferred.

UB Revenue Code, ICD, and CPT/HCPCs knowledge, preferred.