Patient Financial Coordinator

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.

CCRM is an industry leading pioneer in fertility science, research and advancement, offering access to national network of award-winning physicians, a full suite of fertility services, innovation technology and cutting edge labs. CCRM is currently comprised of eleven locations spanning the U.S. and Canada with growth planned for continued network development on a domestic and international basis.

ESSENTIAL FUNCTIONS:

Insurance Verification:

• 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, re-verify or cause to have re-verified, 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.

Pre-certifications:

• 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.

IVF Audits:

• Perform IVF Audits for patients completing IVF treatment cycles
• Post any resulting transactions required as a result of the audit’s outcome.

Other:

• 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.
• Other duties as assigned.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in related field, or equivalent relevant work experience.
• 2+ years of experience in a professional work environment.
• 2+ years of experience in a medical/healthcare office setting, preferred.
• Must enjoy serving patients and having interaction with them, particularly in this subspecialty of medicine.
• Knowledge of or strong 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
• Ability and comfort with collecting amounts due from patients
• Ability and comfort in counseling patients regarding alternatives should they be unable to pay for services.
• Proficient with Microsoft Office programs, specifically Word, Excel, and Outlook. o Excellent interpersonal and communication skills, an outgoing personality, with a professional demeanor and positive attitude
• Must have excellent communication skills; must be able to communicate positively and professionally with all staff members and patients.
• Strong attention to detail, excellent organizational skills and excellent multitasking abilities.
• Demonstrate the ability to be a team player and possess a willingness to perform duties that are assigned or delegated to him/her as well as a willingness to perform duties of other employees as needed.
• Support vision and mission of CCRM.
• Maintain confidentiality of all work information.
• Demonstrate an ability to function successfully in a team environment.
• Exhibit courteous, compassionate and respectful treatment of internal and external customers. Displays a positive attitude and flexibility in changing situations.
• Participates in identifying problems and suggesting solutions.
• Maintains HIPAA and Confidentiality for all patient and clinic information, HIV confidentiality.
• Understands and asses for domestic violence and child abuse issues and reporting responsibilities. Will report concerns to Medical Director or Practice Administrator. o Utilizes time efficiently.
• Ability to work weekends, evenings and holidays, on a rotating basis with other teammates.

WORK ENVIRONMENT

This job operated in a professional office and clinical setting with daily use of surgical instrumentation and equipment; daily use of chemicals such as Formalin; daily use of medical supplies, equipment and materials. This role routinely uses standard office equipment such as computers, including computer keyboards and mice; telephones; photocopiers; scanners; filing cabinets.

The duties of this position involves an inherent potential for mucous membrane or skin contact with blood, body fluids or tissues or a potential for spills or splashes of them. Appropriate protective measures are required for every employee engaged in these tasks. The duties of this position also involves occasionally exerting 75 pounds of force, and/or up to 35 pounds of force frequently.

While performing the duties of this job, the employee is regularly required to talk, see and hear. The employee is frequently required to sit; will occasionally stand and/or walk; use hands and fingers to grasp, pick, pinch, type; and reach with hands and arms. Employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; operation of standard office machines and equipment.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

EQUAL EMPLOYMENT/ANTI-DISCRIMINATION CCRM is an equal opportunity employer and does not discriminate on the basis of Race, Color, Religion, Creed, National Origin, Ancestry, Sex, Pregnancy, Age, Sexual Orientation (including transgender status), Physical or Mental Disability, Marriage to a Co-Worker, or for anyone engaging in Protected Activity (opposing a discriminatory practice or participating in an employment discrimination proceeding). Additionally, this employer does not tolerate any employees engaging in discriminatory behavior based on any of the aforementioned protected classes.