The Financial Counselor – Financial Clearance is a hospital-based, semi-skilled position responsible for conducting eligibility screenings, assessing patient financial requirements, counseling patients on insurance benefits and copayments, and providing onsite customer service for billing questions. This role ensures secured reimbursement to DCH prior to services or patient discharge, mitigates at-risk accounts, and reviews accounts for potential financial assistance. The position works closely with vendors, billing, and case management teams to support optimal financial outcomes.

1. Interviews patient to obtain legal relevant medical information and all required documentation for eligibility determination and accurate application completion avoid rejections /delay in payment; increase to AR.
2. Screen and evaluate patients for existing insurance coverage, federal and state assistance programs or hospital charity application.
3. Screen uninsured patients for state and federal insurance programs; Medicaid, All       Kids Marketplace, Medicare or VA Programs. 
4. Counsels patients on insurance benefits, copayments, and coinsurance amounts. Assist patients with payments, payment plans, or applicable options to ensure DCH is reimbursed for services rendered.  
5. Operates as collector to accept patient payments via cash, credit or checks. Documents applicable systems and provides patient receipts.
6. Ensures all insurance, demographic, and eligibility information is entered into the EMR accurately and appropriate signatures are obtained on all required forms for clean claim processing.
7. Serves a liaison between the patient, hospital and governmental agencies; actively involved in financial areas of case management for supportive patient advocacy for best patient experience.  
8. Initiates and completes charity application on at risk accounts or items not obtained at the time of registration to avoid financial loss or payment denial for DCH.
9. Maintains proper follow-up with the patient and governmental agency caseworkers to ensure timely processing to include request for additional information.
10. Works report each week and documents account notes of application status for all pending applications.
11. Escalates at risk accounts to leadership.
12. Reviews financial data and multiple program requirements to determine possible Marketplace eligibility or other government insurance.
13. Determines estimates for patients to secure adequate payment arrangement with patient for scheduled services in compliance with No Surprise Act.  
14. Provides reports and analysis to Assistant Director on insurance discoveries or secured Medicaid, Marketplace or charity applications.
15. Participates in process improvement activities and efficient workflow between Patient Access and Billing for Clean Claim Processing.
16. Exercises problem solving skills independently or within a group setting for best financial outcomes.
17. Verifies or re-verifies benefits or initiates or obtains authorization and/or referrals to include validation of traditional or HMO plans, commercial coverages within payer timelines to ensure reimbursement to DCH.
18. Works collaboratively with Case Management and Discharge Planning for awareness of community resources to engage patient and family members as needed.
19. Maintains understanding of all regulatory, HIPAA and payer guidelines.

DCH Standards: 

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.

• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.

• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.

• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

1. Associate Degree OR High School diploma/GED with prior advocacy/Revenue Cycle experience of a least two years in a healthcare setting.
2. Must be able to use computer efficiently to register patients in a timely manner. 
3. Good communicate skills.  Must have a pleasant voice and speak with clarity.
4. Must be able to interact well with the public and staff.
5. Must be able to read, write and speak English.

WORKING CONDITIONS

Carry up to 30 pounds, occasionally required to push, pull, bend and lift.  Ability to push a wheelchair, assisting with entry or exit.  Able to stand, walk, kneel, sit or stoop with good balance for extended periods of time or when visiting patient rooms or clinical units to interview patient and obtain information. Vision and hearing normal or corrected to normal.  Can write legibly.  Must have ability to communicate with others.  Mental capability to maintain patient confidentiality 100% of the time.  Subject to stress and fatigue