Financial Counselor

 
Position: Financial Counselor

Job ID: 147959

Location: US-TX-Houston

Department: WC FINANCIAL COUNSELORS

Talent Area: Finance

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.

Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, a second community hospital opening in 2017. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.

To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.



Summary:

We are searching for a Financial Counselor (West Campus) – someone who works well in a fast-paced setting. In this position, you’ll be responsible for completing insurance verification on all new admissions assigned by the Manager or Director, and for ensuring that all assigned inpatient/outpatient visits contain complete and accurate demographic and financial information. This role will be primarily responsible for working with international payers, financial institutions, and foreign hospitals to secure financial coverage for international patients.

 

Think you’ve got what it takes?



Responsibilities :

  • Performs insurance verification, determines primary, secondary, and tertiary payers and follows up on inpatient and outpatient accounts throughout the entire course of treatment
  • Contacts insurance company (s) and notifies them of the patient’s admission within 24 hours of admission in accordance with Payer’s contracted guidelines
  • Adheres to the Hospital’s contractual guidelines with insurance companies when obtaining initial or continuing authorization for services
  • Utilizes the Work Queue daily to track the status of accounts placed on hold by other departments (i.e.: medical records, pre-admit teams, and patient accounting)
  • Verifies pharmacy benefits for all Hematology/Oncology, Cardiology, Neonatology, and other assigned service patients to determine if assistance will be needed for discharge medications as documented in account notes and phone records
  • Reviews Work Queue for transplant patient and contacts the transplant coordinator to determine if the visit is transplant related or disease management
  • Secures scheduled clinic visits prior to the date of service
  • Provides International Patient Services with an estimate for both physician and facility charges prior to visit based on information provided by the International Patient Services
  • Meets with the family regarding their financial status to determine potential assistance for third party coverage in a timely and sensitive manner
  • Remains up to date on policies and, specifically, knows how to interpret the Federal Poverty Income Limit (FPIL) [also known as Federal Poverty Guidelines (FPG)] Chart
  • Identifies patients with potential eligibility for government assistance or other programs (i.e. Medicaid, Medicare, HIPP, CSHCN, CHIP or internal/external charity) by reviewing the Patient Work Queue and the Financial Counselor Work Queue daily
  • Communicates with the families and/or guarantors to screen for financial assistance using the government assistance guidelines and the Hospital’s charity matrix if the patient is self-pay or under-insured
  • Ensures that applications for government assistance (Medicaid) are completed as soon as possible, refers any case to the Corporate Partner (Cardon) where the patient/guarantor has not cooperated with the application process contact
  • Makes every effort to minimize the loss of reimbursement for both inpatient and outpatient visits by securing coverage prior to discharge (unscheduled admissions) or during the patient’s visit
  • Reviews all accounts assigned every seven days until discharge to determine if additional authorization is needed; if benefits are near exhaustion (also by estimating physician’s expenses); or if the payer is still the primary payer, by contacting both the payer and the insured’s employer
  • Makes every effort to minimize the loss of reimbursement for lack of notification in accordance with contracts with payers, lack of authorization, or denied days due to lack of continuing authorization
  • Assists the patient/guarantor in obtaining other resources (i.e. Medicaid, HIPP, CSHCN, CHIP, Medicare, internal/external charity) if eligibility has been terminated or if it is determined that the coverage is inadequate to cover the services needed
  • Maximizes the efficiency and accuracy of the collection process on scheduled patients
  • Maximizes collections by reviewing the schedule of pre-admissions and contacting the family or guarantor with the estimated liability portion due at the time of admission
  • Estimates and collects large deposit amounts from self-pay patients with an unsecured funding source based on diagnosis, clinics visited, and services provided, and for maintaining a record of amounts quoted, collected, used, and available
  • Meets with patients and their families while patient is in-house to determine if patient may qualify for financial resource help
  • Quotes co-payments, deductibles, and estimates for coinsurance, according to policy and contracts, to parents/guarantors, and obtains approval from management for various payment options that ensures compliance and minimizes collection expenses
  • Participates in the department’s process improvement program
  • Monitors and evaluates the specific responsibilities of a Financial Counselor to identify key services and processes that have potential for improvement in outcomes, reducing the number of defects and increasing customer satisfaction
  • Supports potential process improvement projects by collecting and compiling metrics that support the success of the improvement initiative
  • Presents proposal for process improvement either verbally and/or written
  • Provides required documentation in the patient’s chart, including signed forms such as general consent, information release, advanced care directives, and other documents required by JCAHO and other regulatory bodies, and obtains required signatures


Qualifications:

  • S. Diploma or GED is required
  • Bachelor’s degree with business emphasis is preferred
  • 2 years of related experience is required
  • Knowledge of how managed care plans work and the requirements for insurance coverage
  • Ability to comprehend detailed payment methodology knowledge of eligibility requirements for Medicaid, Medicare, CSHCN, and the Hospital Charity program
  • Ability to multi-task
  • Must possess excellent verbal and written communication skills
  • Ability to demonstrate high level of professionalism to ensure collectability of all assigned patient accounts
  • Ability to handle difficult financial, clinical, and social situations


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