Financial Counselor - Specialty Pharmacy

 
Position: Financial Counselor - Specialty Pharmacy

Job ID: 155564

Location: US-TX-Houston

Department: SPECIALTY PHARMACY

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, the first hospital devoted to children’s care for communities north of Houston. 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 -- someone who works well in a fast-paced setting. The Financial Counselor works with financial institutions and foreign hospitals to secure financial coverage for patients. Additionally, the Financial Counselor may be utilized as overflow coverage and is accountable for responsibilities outlined in the respective job description.

 

Candidates that have the following experience and skills are encouraged to apply!

  • Managing PBM reimbursement in the pharmaceutical industry
  • Maintaining documentation and submissions for PBM/340 audits
  • Resolving complex billing issues and rejection codes for third party claims and prior authorizations
  • Serving as a liaison to specialty pharmacy team for appropriate claims processing and adjudication
  • Strong written and verbal communication skills
  • Strong analytical and financial analysis skills
  • Ability to build and maintain strong relationships internally and externally

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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Evaluates patient for applicable advanced care directive and documents existence of, or referral to Social Services for additional assistance


Qualifications:

  • High school diploma or GED required
  • Bachelor’s degree with an emphasis on business preferred
  • 2 years related experience preferred


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