Patient Benefit Counselor- Riverside 3

Responsible for assessing patient’s eligibility for all available financial programs, ability to pay expected/estimated balances and available payment alternatives. Makes financial arrangements for patients without insurance coverage and for the underinsured; assists patients in obtaining financial sponsorship from outside agencies and charitable programs when financial need is indicated. Researches account history and collects or arranges payment plan at point of service for bad debt accounts when appropriate. Collects patient portions and deposits from patients at or before point of service.
 

• Frequently completes a combination of face to face or phone interactions with patients in often challenging environments to gather information and effectively counsel patients on various types of available financial assistance. This applies to multidisciplinary team and across the patient’s continuum of care. Conducts interviews and negotiates with patients, relatives, hospital personnel, and other third parties to secure verifications and supporting documentation to be furnished to providers and medical assistance offices in order to enhance opportunities for reimbursement. 
• Completes verifications of insurance benefits and eligibility based on established screening criteria; and completes comprehensive fieldwork to gather information for the review of referrals. Assertively facilitates applications and secures verifications and documentation. Performs analysis; determines eligibility; and evaluates ROI/cost effectiveness of working on the account. Maintains a working knowledge of insurance plans to accurately determine patient financial liability and payment obligations and to provide knowledge to customers.
• Uses a variety of technology and tools to complete and review assistance applications to assess patient’s eligibility for available financial assistance programs. May conduct analysis of patient’s outstanding and bad debt accounts and collects appropriate payment when applicable. Coordinates with multiple Carilion disciplines to identify and form action plans for accounts which may place the health system at financial risk.
• Provides recommendations for process improvements and assists in the development of Carilion programs including but not limited to quality of data, performance monitoring, and regulatory requirements. 
• Demonstrates and applies a basic knowledge of Medicaid, SLH, Auxiliary Grant, and a thorough knowledge of Billing and Collection Policy, Financial Assistance, MedKey, and hospital payment plan eligibility rules, regulations and procedures in order to assure accurate processing of accounts for billing and reimbursement.
• Prepares accurate price estimates and determines patient financial responsibility; consistently educates patients regarding complex insurance benefits and confidently collects co-pays, deposits and other patient payments (including coinsurance and deductible estimates) while upholding the highest customer service standards. Maintains secure cash box, log of payments and documentation related to the job description. Enters or verifies patient registration demographics and makes corrections, as needed.
• Screens for legal action pending on patient/guarantor accounts and arranges support with legal coordinators.