Job Description :
The primary of responsibility of this job holder is to responsible for processing pre-authorization requests submitted by clinical departments manually or through the Cerner Health Information System.
He / she is also responsible for working with patients to insure the hospital receives maximum payment for all services rendered, while assisting the patient with any and all avenues of financial assistance available to them.
The Incumbent is required to interact with patients and families related to specific sections in the medical affairs as and when required.
The Senior Financial Counselor is also required to have extensive communications with insurance providers as well as Companies clinical staff to resolve matters related with the specific domain assigned.
The incumbent is responsible to train staff the Financial Counselor I position holders.
Key Role Accountablities :
Advises and counsels patients and guarantors as to rights, responsibilities and procedures with regards to payment for care.
Responds to patients’ insurance benefit questions, generate charge estimates and assist with making payment plans.
Addresses all questions and concerns in courteous professional manner.
Liaises with patients / families to identify the most appropriate account resolution.
Coordinates with patients / families on method of payment and establishes payment arrangements / plans if patients have problems with payment.
Creates payment plans tailored to the needs of patients / families after thorough evaluation, this may include a pre-procedure deposit as well as a monthly payment agreement.
Assists patients / families with financial assistance applications as needed and completes charity processing for assigned patients, as appropriate.
At discharge, ensures to collect the remaining balance from patients / families.
At the end of the shift, reconciles the amounts collected from patients with the amounts on the payment transactions report generated from the system and reports any discrepancy amount if any.
Processes assigned pre-authorization requests through manual and electronic internal referral systems.
Prioritizes pre-authorization requests.
Submits and follows up pre-authorization requests prepared by Financial Counselor I and other inquiries to the NHIC (National Health Insurance Company) and other insurance providers.
Communicates with assigned clinical staff departments to obtain additional information as required by the insurance provider or the payer.
Performs urgent pre-authorization requests in a timely manner in agreement with Manager of insurance and escalates issues to senior financial counseling staff on as needed basis.
Works with health insurance providers and key departments to promote an understanding of pre-authorization requirements and processes.
Updates the system with the outcomes of the pre-authorization requests (approval, partial approval, reason of decline or request of additional information, etc.).
Notifies the concerned staff about the outcomes of the pre-authorization requests.
Maintains proper logs and documentation on assigned requests.
Participates in departmental process improvement activities.
Maintains confidentiality of all patients and medical / clinical information.
Performs other functions as necessary to accommodate departmental change, workload and emergencies.
Adheres to Companies policies and procedures; code of conduct and privacy confidentiality standards
Assists in cash collection from patients / families : performs down payment transaction in system, generates receipt voucher and collects down payment amounts / co-
payments and other out of pocket amounts from patients
Provides training for new Financial Counselors I and conducts additional training on as needed basis
Ensures appropriate signatures are obtained on all necessary forms.
Bachelor Degree in Commerce, Health Information, healthcare field or related field
3+ Years’ experience in a healthcare facility.
At least one year experience in a similar role as financial counselor or patient access office.
Job Specific Skills and Abilities :
Demonstrated organizational and time management skills.
Demonstrated knowledge of medical insurance and coverage.
Demonstrated ability to understand medical terminology.
Demonstrated ability to prioritize work.
Demonstrated ability to analyze and do due diligence investigations.
Demonstrated ability to be flexible and responsiveness to changing workloads.
Demonstrated skill in Customer Service and effective and tactful communications with patients / families during stressful situations.
Excellent interpersonal skills.
Proficiency with Microsoft Office suite.
Fluency in written and spoken English and Arabic