Financial Counseling Representative, Price Estimates
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Job Description
Financial Counseling Representative at Sanford Health providing assistance with billing, insurance, and payment arrangements for patients. Educating patients on insurance concepts and financial responsibilities involving medical services.
Responsibilities:
- Answers billing questions.
- Reviews patient's insurance coverage and Explanation of Benefits (EOBs).
- Provides clarification regarding what charges were incurred and why they were incurred.
- Reviews insurance denials and provides an explanation for the denial to the patient.
- Reviews payment plan guidelines and assists in setting up payment arrangements.
- Determines if patient is eligible for payment assistance programs and assists in the application process, if applicable.
- Educates patients regarding insurance concepts, such as what copayments are, what services are covered, effective dates of coverage, when a referral is needed and the effect on insurance, how to obtain a valid referral and resubmit the claim, and how effective dates of coverage influence insurance payments.
- May assist patient in filling out medical assistance program paperwork, as well as referrals to Medicaid or other insurance aid or disability programs.
- Frequently advises uninsured patients on outstanding medical costs associated with procedures performed in a clinic setting and establishes a payment plan.
- Interacts with patients in-person and must be able to empathize with them while also diffusing strong emotions.
- Calculates and provides cost estimates for medical procedures, including the patient's anticipated share.
- Advises on and collects prepayments for services not covered by insurance.
- May perform guest service duties, as needed.
- Other duties as assigned.
- Computer skills sufficient to operate on-line systems and complex software with advanced functionality.
- Oral and written communication skills sufficient to interpret and apply policies and procedures for clarification and problem resolution.
- Knowledge of third party payers and basic bookkeeping or accounting principles is required.
- Requires a thorough understanding of insurance products and the ability to accurately read an EOB to determine what adjustments have been made, what payments have been received, and calculate pending balances.
Requirements:
- High school diploma or equivalent preferred.
- Post-secondary education preferred.
- Two years' experience in healthcare service or health insurance preferred.
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