Financial Counselor - Pennsylvania Hospital
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Job ID: 201504
Category: Customer Service/Patient Access
Work Type: FT
Location: Philadelphia, PA, United States
Description
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Summary:
- Verification of benefits and pre-certification of all urgent and emergency admissions. Obtains benefits, referrals and confirms authorizations on scheduled cases for which the Physician Practices are responsible to obtain authorizations. This position will ensure access to integrated healthcare; achieve clinically appropriate authorization to assure optimal reimbursement for the hospital for services provided.
Responsibilities:
- Maintain communication with and provides education to all involved departments including but not limited to Patient Access, CRM, Physician Practices and their designees
- Obtains detailed and accurate insurance benefit information with given ICD-10 and CPT codes, which is updated in EPIC Hospital Account Notes using standard documentation (including but not limited to effective date, expected reimbursement, patient financial responsibility, referrals, etc.).
- Identify and proactively follow-up on all out of network and underinsured cases to ensure appropriate reimbursement
- Communicate with patients to verify incomplete insurance information.
- Notify HMO patients and Physician Practices regarding referrals in order to obtain prior to date of service.
- Financial counsel patients about co-pays and financial responsibility
- Pre-Certify and obtain authorization numbers, which are updated in patient’s EPIC account
- Use online verification tools and fax to submit all information required to insurance companies to obtain an authorization number for pre-cert
- Maintains standards set by the Office of Compliance and HIPPA in reference to confidentiality
- Daily follow up with insurance carriers on all pending authorizations and referrals
- Maintains EPIC Workque list by coding accounts as they are updated and/or completed
- Team Player who displays a positive attitude. Available to assist Teammates in sharing workload and coverage during absence
- Maintains excellent working relationship and communication with insurance companies and departments
- Provides accurate, detailed information to Patient Accounting and CRM to ensure facilitation of approved encounters and timely claim reimbursement
- Receives and provides ongoing education and exhibits a willingness to share current knowledge with Team members as necessary to help meet organizational goals
Credentials:
Education or Equivalent Experience:
- H.S. Diploma/GED (Required)
- And 2+ years hospital financial services/business office
Live Your Life's Work
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.
