Reports to: Manager, Patient Financial Services and Practice Manager
Job Summary: The Patient Financial Coordinator (PFC) serves on the Patient Care Team together with the Patient’s Primary Nurse to coordinate the financial aspects of the patient’s care. Together with fellow team members, the PFC works toward creating a positive and memorable patient experience. The PFC ensures that patients are well educated about the financial and insurance aspects of their care, and that steps are taken by the practice to ensure that proper payment is received from the patient or the patient’s insurance company on a timely basis. The PFC serves as a resource to patients regarding financially-related matters such that they are accessible to patients for ongoing questions regarding this aspect of their care.
Knowledge, Skills and Abilities:
- Enjoys serving patients and having interaction with them.
- Excellent interpersonal and communication skills, an outgoing personality, with a professional demeanor and positive attitude
- Excellent organizational skills with an ability to multitask and effectively prioritize
- Team player
- Knowledge of or ability to conceptualize and learn financial and insurance concepts inherent in patient financial services and specifically this subspecialty area of medicine
- Strong analytical skills and the ability to effectively read, generate and analyze reports
- Comfort with collecting amounts due from patients
- Comfort in counseling patients regarding alternatives should they be unable to pay for services.
- Ability to use electronic spreadsheets
- For all patients, perform insurance verification both prior to the New Patient (NP) appointment and prior to the start of any treatment cycle.
- Ensure insurance benefits have been input into the practice management system.
- For patients that have a change in insurance during their course of care, reverify or cause to have reverified, the patient’s insurance, and input the result of same into the practice management system.
- Ensure that insurance is attached on the chart level for all patients; for existing patients with a change in insurance, ensure that a change of insurance attachment on the chart level has been performed.
New Patient Benefit Consults
- Meet with NP’s at their NP appointment and explain that the Financial Coordinator will be the patient’s primary point of contact for all financially-related matters during their course of care.
- Review with NP’s the insurance coverage that exists in their insurance policy or policies, should the patient have primary and secondary coverage.
- Explain to the patient the practice’s guidelines and policies for Patient Financial Services.
- Address any discrepancies between the patient’s understanding of their insurance coverage and the benefits relayed to ACRM upon verification.
- Other duties as assigned.
- For each patient assigned to the team, know the pre-certification requirements of the patient’s insurance policy and payer.
- Using system reports identify all instances where pre-certification is required of any general medical service, infertility diagnostic service, infertility treatment service, obstetrical care service, or any other service so specified by the patient’s insurance company.
- Perform such pre-certifications or pre-authorizations.
- Determine patient responsibility amounts based on the pre-certification performed. Communicate with the patient via phone or secure portal messaging the patient responsibility amount to be paid in advance of the related procedure.
- Ensure that written pre-authorization documentation is received, when such written documentation is required, in advance of the patient proceeding with care.
Assisted Reproductive Technologies (ART) Financial Consults and related Collection of ART Patient Responsibility Amounts
- Through the use of specified reports, and through the communication with respective team members, identify patients who will be proceeding with ART care.
- Meet with all such patients to provide an ART Financial Consult, explaining to the patients the expected coverage from their insurance company, if any, and the amount that will be patient responsibility.
- Collect ART related patient responsibility amounts in accordance with Practice guidelines (e.g. two weeks before baseline).
- Determine patients for whom funds have and have not been collected for ART care to ensure that the Primary Physician is consulted regarding any patient who is approaching the beginning of care but has not paid their patient responsibility.
- Create, for Patient Account Representatives at check-out through the use of system alerts, ART collection and practice management system posting instructions for patients based on the allocation between insurance coverage and self-pay responsibility.
Shared Risk (ASSURE) Program Responsibilities
- Coordinate with team members to ensure that clinical data required in the ASSURE application has been completed.
- For all ART patients, explain thoroughly the various programs offered through ASSURE, and answer any questions the patient may have regarding this.
- For patients deciding to use the ASSURE program, coordinate with the program and the Patient Care Team, such that the ASSURE contract is executed by the patient with funds paid to the program, prior to the beginning of the treatment cycle.
- For subsequent ASSURE cycles for a given patient, ensure that clearance has been given by the ASSURE program for the patient to proceed as an ASSURE cycle. Coordinate with the Patient Care Team regarding this clearance to proceed from ASSURE.
- Through the use of designated reports, file clinical information and payment requests to the ASSURE program upon egg retrieval for fresh cases or embryo transfer for frozen cases.
- Monitor the A/R Aging Report for Payer-ASSURE to determine that payment is received on a timely basis.
- Perform IVF Audits for patients completing IVF treatment cycles
- Post any resulting transactions required as a result of the audit’s outcome.
- Serve as a Patient Advocate for patients when patients have difficulty navigating with their insurance company.
- Respond to all patient inquiries, via either phone, email or in person, regarding their account and insurance related matters.
- Serve as a resource to Physicians, Nurses and Patient Care Coordinators regarding any possible impact insurance coverage limitations may have on the patient’s care plan.
- Serve as a resource to Patient Account Representatives performing Financial Review, when questions arise regarding specific patient’s accounts.
- Attend scheduled team meetings as an active and contributing participant in the Patient Care Team.
EQUAL OPPORTUNITY EMPLOYER
CCRM is an equal employment opportunity employer and complies with all applicable laws relating to discrimination against qualified applicants or employees in hiring or in any decision affecting job status, pay, or any other terms and conditions of employment based on race, color, creed, religion, national origin, sex, marital status, familial status, disability, genetic information, sexual orientation, age, or other applicable protected classes.
To apply for this job email your details to firstname.lastname@example.org