Financial Counselor

Children’s Hospital of Philadelphia (CHOP) is seeking a Financial Counselor to join their team. The role involves managing insurance verification, conducting benefit reviews, and providing financial assistance assessments to patients seeking care, while ensuring effective communication with families and providers regarding insurance matters.

Responsibilities

• Responsible benefit detail and authorizing the services
• Demonstrates an understanding and provides information of benefit structures to patients, physicians, and hospital practices as well as provides information on the following areas: Hospital prompt pay and payment plan policies
• Authorization issues
• Contract participation
• Process for pre-cert/pre-auth of non covered services
• Provider ID numbers & CPT codes (if applicable)
• Verify coverage & benefit information via electronic eligibility or by contacting payor and documenting relevant information in Epic
• Follows up with insurance companies and families of patients identified as ineligible or non-covered
• Contacts family and/or responsible party, as necessary, to inform them of any financial assistance or insurance applications statuses, insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party
• Contact clinical office with all information that requires follow-up
• Support financial assistance assessment and/or insurance applications to obtain coverage as needed
• Responsible for review, vetting, and dissemination of all Philadelphia Health Center Referrals, and Community Partner referrals received by Department
• Educates families and clinical team regarding insurance coverage plans
• Stay abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy
• Leverages benefit collection information and Epic tools to clear services and create estimates for services
• Respond to emails, answer calls, provide explanation of covered and non-covered services
• Contacts appropriate clinical staff in timely manner with all information that requires follow-up
• Authorization responsibilities
• Review diagnosis/procedure codes to ensure they are documented correctly and accurately reflect the clinical information and services to be performed
• Discuss and send pertinent medical history to complete authorization process
• Discuss, interpret and send pertinent medical history to complete authorization process (inclusive of pre-determinations)
• Work on complex medical cases that are in pending status until cases are complete and works with clinical teams for additional clinical information and/or a letter of medical necessity
• Notify physician office/hospital of coverage issues, denials due to procedures not medically necessary, or if insurance carrier requires additional clinical information and/or peer to peer requests
• Prioritize daily requests based on date of service, insurance carrier requirements, unexpected date changes or urgent requests, while processing request within department standards
• Coordinates appeals or retrospective review as needed following up on payor denials
• Ability to convert common diagnosis descriptions to numeric ICD 9 or CPT code
• Partner with specialist to outline correct CPT Codes, NPI, and authorization details for specific services for Single Case Agreement

Skills

• High School Diploma / GED Required
• Strong professional phone presence
• Independent judgment
• Advanced knowledge of insurance and registration processes
• Comprehensive insurance verification
• Financial assistance assessments
• Detailed benefit collection and authorization processes
• Manage insurance verification
• Conduct in-depth benefit reviews
• Identify covered and non-covered services
• Clearly explain benefit structures
• Maintain proactive communication with families, providers, and payors regarding referrals, authorizations, FHCP eligibility, and a wide range of insurance eligibility and service authorization matters
• Provide cross-coverage support across other areas as needed
• Responsible benefit detail and authorizing the services
• Demonstrates an understanding and provides information of benefit structures to patients, physicians, and hospital practices
• Verify coverage & benefit information via electronic eligibility or by contacting payor and documenting relevant information in Epic
• Follow up with insurance companies and families of patients identified as ineligible or non-covered
• Contact family and/or responsible party, as necessary, to inform them of any financial assistance or insurance applications statuses, insurance problems or restrictions
• Support financial assistance assessment and/or insurance applications to obtain coverage as needed
• Responsible for review, vetting, and dissemination of all Philadelphia Health Center Referrals, and Community Partner referrals received by Department
• Educate families and clinical team regarding insurance coverage plans
• Stay abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy
• Leverage benefit collection information and Epic tools to clear services and create estimates for services
• Respond to emails, answer calls, provide explanation of covered and non-covered services
• Contact appropriate clinical staff in timely manner with all information that requires follow-up
• Authorization responsibilities
• Review diagnosis/procedure codes to ensure they are documented correctly and accurately reflect the clinical information and services to be performed
• Discuss and send pertinent medical history to complete authorization process
• Work on complex medical cases that are in pending status until cases are complete and works with clinical teams for additional clinical information and/or a letter of medical necessity
• Notify physician office/hospital of coverage issues, denials due to procedures not medically necessary, or if insurance carrier requires additional clinical information and/or peer to peer requests
• Prioritize daily requests based on date of service, insurance carrier requirements, unexpected date changes or urgent requests, while processing request within department standards
• Coordinate appeals or retrospective review as needed following up on payor denials
• Ability to convert common diagnosis descriptions to numeric ICD 9 or CPT code
• Partner with specialist to outline correct CPT Codes, NPI, and authorization details for specific services for Single Case Agreement
• Medical Insurance background
• Strong customer service experience
• Ability to work with stressful situations
• Ability to function efficiently and professionally with minimum of supervision
• Ability to quickly learn new procedures
• Strong computer skills
• Ability to juggle multiple insurance issues
• Strong customer service skills
• Ability to display compassion and empathy
• Mandatory required training within first 30 days: ACD Software Training, Website Insurance Training (Navinet, WebMD, Passport), EPIC training & testing (Prelude/Cadence), Registration Essentials, Cardiac Center databases
• Associate's Degree Preferred
• Background in medical terminology Preferred
• EPIC registration Preferred
• Resource scheduling experience (i.e. ancillary testing) Preferred

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