A Brief Overview This position is dedicated to customer support and financial counseling activities within Revenue Cycle department working with the patient to provide excellent service related to identifying and collecting prior to service, cost for care, prior balances and providing financial options, support and guidance to patients/ families/ representatives as well as UH agencies for both hospital and physician accounts.
The role provides advanced communication and collection on financially risky scheduled patients. The FC possesses strong understanding of medical service coverage and associated 3rd party, governmental and internal policies and options to best serve the patient for patient services provided in the hospital and/or physician setting including appropriate collection, service support practices that aligns with price transparency, consumerism, up to date industry regulations UH requirements for advance notice and collection of elective services.
This role is a patient /family/ customer facing resource responsible to creating exceptional patient experience by providing easy, convenient and personalized service designed to fully resolve and financially clear patients for service. The F/C will remain current with service, policies, and options to best serve the patient. Comprehensive knowledge of revenue cycle workflow including practice / department access and data capture of internal workflow processes and vendor support to prioritize financially risky cases in advance of service dates to appropriately assess and administer options resulting in financial clearance including: full collection, payment plans, loans, state coverage, financial assistance, etc.
Understands how to access options to help the patient meet future and prior unpaid financial obligation. Works with internal and external departments and services in a timely manner. Communicates and documents patient status and escalates and supports the Escalation process, in accordance with organizational policies and procedures patients not cleared for additional decision making.
Works closely with the customer, clinical department and revenue cycle stakeholders to assure status and resolution as appropriate. The role also supports account review and resolution performed using work lists and correspondence received by the department. Is proficient with internal and external applications and solutions to provide high quality and timely service.
The FC supports department and leadership with performing department projects, financial counseling support, review and resolve departmental reports/work lists as well as other departmental duties as assigned. They work in partnership with Corporate Pre-Certification and Operations staff supporting patient quotes, collections, payment options, plans and financial assistance. F/C will understand how to quickly analyze and understand how to resolve accounts related to insurance, as well as patient amounts due including patient benefits for balance after insurance in a timely and accurate manner.
Comprehensive knowledge of UH entity collection and financial assistance policies required in order to support questions/inquiries from under/uninsured patients. Works harmoniously with staff and teams as appropriateThe position works closely with patients/families, staff and leadership to coordinate support for payment plans to ensure accounts are resolved and collected in a timely manner. Works closely with revenue cycle department leadership and staff as well as other corporate and operations department staff where research and hand offs are necessary to resolve cases accordingly.
Creates positive relationships as a credible resource supporting patient loyalty. The FC fully understands customer service key performance indicators and works to consistently achieve these metrics including patient satisfaction through survey submission, productivity and department collections.
- Provides excellent service and timely support. Performs assessment and collections activity on pre-service scheduled cases to resolve future and previous financial risk or escalate for appropriate review and approval in a timely manner (75%)
- Generate patient estimation of services as applicable and collect the specific deposit amount as outlined in UH policy
- Monitor, prioritize, collect and resolve self-pay accounts in accordance with standard operating procedures
- Assist patients with payment plan arrangements including collecting initial down payment as part of the process by following established departmental policy
- Monitor and work Financial Counselor worklist for respective locations and validates against the Encounter Prep Worklist to ensure all scheduled patients have been financially cleared
- Escalate financially risky accounts through designated escalation team for appropriate clinical and financial assessments
- Process payments by phone via electronic check, credit card, hard copy, payment database or any other approved means
- Identifies other options to resolve financial obligation that results in financial clearance.
- Continues to learn about industry leading practice to share and adopt as appropriate with leadership Informs patients and executes financial assistance opportunities (15%)
- Understand, explain, execute and help determine eligibility for hospital financial assistance programs
- Coordinates with agencies and other departmental vendors as appropriate to ensure eligibility for possible insurance coverage or government programs has been thoroughly reviewed and pursued
- Works with internal and external resources as appropriate to support the patient with their education and understanding of coverage and/or payment options Coordinates customer service support for patients inquiring about their account (10%)
- Identify patient or customer needs, clarify information, research and analyze issues, and provide solutions and/or appropriate alternatives
- Conduct a warm transfer to the Customer Service department via phone or email of the patient’s inquiries providing necessary details to ensure a positive patient experience
- Escalates as appropriate directly to the Customer Service Escalation Team for sensitive patient inquiries requiring immediate attention Other patient facing and customer support expectations
- Maintains patient and physician confidentiality and professionalism in accordance with departmental and HIPPA guidelines at all times
- Consistently communicates issues and helps to review and implement people, process and technology improvements as appropriate
- Complies with training requirements related to process and solutions available to support workflow
- Assists in the analysis of claims resolution and provides feedback to management to put in place solutions and process improvements
- Assists in the development of new procedures/process with a focus on improvement in quality and quantity of work performed
- Assists in the establishment of performance goals, monitors compliance Additional Responsibilities Performs other duties as assigned. Complies with all policies and standards. For specific duties and responsibilities, refer to documentation provided by the department during orientation. Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. Education High School Equivalent / GED (Required) Work Experience 5+ years experience in revenue cycle or healthcare related field (Required) and 1+ years direct Revenue Cycle Customer or Service Department, collection agency or sales experience (Preferred) and Experience with medical billing software (Required) Knowledge, Skills, & Abilities Knowledge of managed care insurance requirements is essential (Required proficiency) Investigative/ research skills to identify financial options for patients. (Required proficiency) Exceptional written and verbal communication skills (Required proficiency) Proficient with digital systems, applications and workflow. (Required proficiency) Advanced knowledge of medical billing and claims terminology and workflow processing. (Required proficiency) Consistently demonstrates advanced analytical and problem solving skills. (Required proficiency) Exceptional client service, communication, and relationship building skills. (Required proficiency) Advanced knowledge of claim submission (UB04/HCFA 1500) and third party payers. (Required proficiency) Self-motivated, works independently and consistently demonstrates the ability to perform with little to no supervision in a fast-paced environment. (Required proficiency) Demonstrated proficiency with PCs, with HIS systems as well as Microsoft software Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency) Licenses and Certifications Certified Healthcare Access Associate (CHAA) (Preferred) Physical Demands Standing Occasionally Walking Occasionally Sitting Constantly Lifting Rarely up to 20 lbs Carrying Rarely up to 20 lbs Pushing Rarely up to 20 lbs Pulling Rarely up to 20 lbs Climbing Rarely up to 20 lbs Balancing Rarely Stooping Rarely Kneeling Rarely Crouching Rarely Crawling Rarely Reaching Rarely Handling Occasionally Grasping Occasionally Feeling Rarely Talking Constantly Hearing Constantly Repetitive Motions Frequently Eye/Hand/Foot Coordination Frequently Travel Requirements 10%