Financial Care Counselor - Duke Health Center of Clayton

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Duke Health Integrated Practice

Duke Health Integrated Practice comprises more than 110 primary and specialty outpatient clinics, extending the reach of Duke Health's mission across the state of North Carolina.

$5000 Commitment Bonus for qualifying candidates! 

JOB LOCATION

Duke Health Center of Clayton - 95 Springbrook Ave

JOB SUMMARY

We are seeking a Financial Care Counselor (FCC) to be an integral part of the patient care team in the clinic/service area and is responsible for the revenue cycle patient access activities related to but not limited to financial counseling and clearance of patients to include service specific authorizations and referrals. The FCC will need to accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration and registration functions. Ensure all insurance requirements are met prior to patients' arrival and inform patients of their financial liability prior to arrival for services. Arrange payment options with the patients and screens patients for government funding sources. 

JOB DUTIES AND RESPONSIBILITIES

Patient Identification & Insurance Verification:

• Perform an in-depth review of accounts to review and resolve warnings, alerts and confirmation checks presented; execute appropriate process / corrections / updates (for example MSPQ.)
• Assess the current financial situation of patients through the verification of benefits; serving as the technical expert for reimbursement and the interpretation of benefits to maximize patient coverage.  Maintain proficiency in verifying insurance eligibility and obtain benefits via all methods (e.g., integrated vendor eligibility solutions, phone, fax, or payer website). 
• Contact Risk management / Workman’s Compensation to determine financial liability. Coordinate registration and billing for covered services and update all information in Epic.
• Maintain an understanding of unique patient pricing structures (e.g., retail priced, non-covered) that reduce a patient’s coverage for full benefits and renders them under-insured.  Communicate the financial circumstances to patient and physician as early as possible.  Assist in evaluating a coordinator clinical and financial plan to maximize the patient’s benefit coverage. 

Provide Patient Financial Education & Counseling:

• Answer in depth questions on patient facing forms (for example COA/COT, MSPQ, ABN, and Self-Administered Drugs) to ensure understanding of policies and patient requirements. 
• Assist patients in navigating complex personal financial decisions.  Provide guidance on governmental health insurance regulations and commercial health plan requirements to empower patients with an understanding of financial implications and coverage as it applies to current and future visits. 
• Through conversation with the patient, evaluate patient / guarantor assets and liabilities to determine ability to pay for previous, future, and current services.  Prospectively address patient financial responsibility and identify additional funding opportunities to safeguard patients and Duke.  Examine insurance policies and other third-party sponsorship materials for sources of payment. 
• Completely and accurately, document all patient encounters and financial/insurance outcomes to ensure comprehensive audit trail. 
• Provide financial counseling to patients and their families regarding outstanding patient liability –co pays, deductibles, coinsurance and (self-pay) balances for healthcare services.  With provider involvement, determine urgency of scheduled care for patients with large financial liabilities resulting in either a decision to proceed or a decision to obtain sponsorship. 
• Maintain an in-depth knowledge of Duke’s Financial Assistance and billing policies to provide financial advice to patients and their guarantors.  Evaluate patient requests for financial assistance or other medical assistance programs and refer to appropriate group if necessary (MAC team, customer service, and other available.) Assist the patient in completing financial statements and compiling supporting financial documentation. 
• Serve as an expert in site of service authorization and insurance benefit implications to include the patient’s responsibility of co-insurance and co-pay, and the potential for multiple bills.  Inform patients and providers of impact prior to service for evaluation of location change.  Facilitate changes in authorization as required. 
• Prepare patient liability estimates. Calculate required deposits/pre-payments and collect in advance of service or prepare the patient for payment at the point of service
• Implement appropriate collection actions and assist financially responsible persons in arranging payment.
• Apply financial clearance policies (e.g., Out of network, self-pay, Out of County self-pay and Medicaid) ensuring patient and provider education regarding financial responsibility and payment expectations.  Assist Physicians and other Clinical staff in evaluating the circumstances that support exceptions to the financial policies.  Facilitate appropriate approval of exceptions. 
• Counsel patients and complete the managed care waiver form for patients enrolled in plans that reduce/limit benefits at Duke Health (e.g., non-participating, out of network).  Assist the Physician or Clinical staff in redirecting the patient to a choice Provider for their health plan or collect payment up front for services per policy. 
• Maintain familiarity with pharmacy assistance programs to assist patients in the Manufacturer Assistance program application process.  Complete assistance program forms as required.  Register Manufacturer Assistance programs in Epic to streamline the reimbursement process. 

Customer Service, Safety & Work Culture:

• Meet with patients to address questions regarding billed services and patient responsibility.  Explain charges and payment; identify any potential billing errors.  Conduct a comprehensive investigation into all potential billing errors and use available tools to refund, apply adjustments, correct charges, and other account reconciliation activities in accordance with First Contact Resolution.  Collaborate with other departments as required to provide resolution. 
• Identify process improvement opportunities in response to new or revised payer policies, payer reimbursement guidelines, and internal operational workflow changes (e.g., authorization). Communicate recommendations to management to maximize efficiency and effectiveness. 

Pre-Determination / Pre-Authorizations / Authorizations / Referrals:

• Serve as a safety net for authorizations scheduled same day of service and those not completed by day of service.  Obtain authorizations based on insurance plan contracts / guidelines, document in Maestro Care system per policy and procedure. 
• Maintain a knowledge of insurance company requirements by reviewing payer websites, reading payer updates provided by Payer Relations and Service Access, and by attending Service Access monthly education sessions.  Apply knowledge to identify potential process changes when new services are offered within clinic/service area.      
• Communicate with physicians and medical staff to obtain clinical information required for the authorization process as needed. 
• Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients.
• Integrate efforts with case management, social work and the utilization management team as necessary.
• Request a pre-determination when clinical coverage policy does not exist for a new to market device, drug, or procedure. 
• Participate in research to reverse denials or prevent future denials.  Initiate and participate in insurance appeals as required.  Provide feedback to Service Access Manager and/or Team Lead regarding trends in user errors or system errors.  Offer recommendations for improvement. 

Work Queues / Reports: 

• Serve as an expert in the reconciliation of registration and authorization related billing edits and errors that prevent claims filing.  Provide routine feedback to Service Access Manager and/or Team Lead regarding trends in user errors or system errors.  Offer recommendations for improvement.
• Act as a liaison between staff in other departments in the reconciliation of more complex edits that affect services billed across multiple dates of service; instances where registration or authorization changes may result in new errors or denials if not appropriately handled. 
• Assist in the collection of data, as needed, which assists with identifying improvement opportunities in the insurance verification, authorization, or patient billing processes.   

Other Duties / Patient Engagement / Professional Conduct:

• Perform quality reviews on insurance, financial related data (e.g., authorization denials) and identify trends impacting individual and department performance.  Offer recommendations for performance improvement. 
• Use “Words that Work” and “Relate” to effectively deliver financial messages and to clearly articulate financial policies to patients.
• Apply Duke’s values and behaviors to remain customer focus in the execution of daily job duties.
• Uses the approved service recovery guidelines while maintaining composure; determines the best course of action related to patient or clinic concerns and escalates as appropriate.
• Reports errors in work timely to ensure the quality and integrity of work outcomes.
• Perform other duties as listed in the PSA job description and as assigned by clinic leadership.

JOB ELIGIBILITY REQUIREMENTS

• Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred. Additional training or working knowledge of related business.
• Two years experience working in hospital service access, clinical service access, physician office or billing and collections.
• Or, an Associate's degree in a healthcare related field and one year of experience working with the public.
• Or, a Bachelor's degree and one year of experience working with the public.
• Strong verbal and written communication skills mandatory.
• Basic PC skills / data entry experience.
• Ability to organize and prioritize.
• Ability to understand and interpret insurance carrier guidelines and plans.
• Medical terminology knowledge.
• Ability to interact tactfully and courteously with the public.
• Ability to apply specific departmental policies, rules and regulations relating to verifying patient information, collecting payments and maintaining records and forms.
• Ability to establish and maintain effective relationships with other personnel.
• General accounting principles.

JOB HOURS

The schedule for this position is day shifts, Monday-Friday, with no weekends or holidays.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.