Essential Functions
- Complete mandatory Certified Application Counselor courses to obtain state certification, and maintain by completing yearly recertification.
- Reviews assigned worklists/reports daily to identify self pay patients and contacts patients for financial screenings for potential sponsorship/coverage. Communicates outcomes to Patient Access leadership and other internal departments, as necessary.
- Screens patients referred by internal departments for assistance for additional coverages (Care Transitions) or requested reviews for scheduled outpatient visits (Registration/Authorization).
- Interviews, screens, and counsels the uninsured and underinsured patient population, and members of the community in accessing healthcare resources and services to ensure reimbursement is obtained for medical services provided.
- Visits patients at risk of non-covered denials based on insurance and provides education on financial assistance options
- Receives and sends information to hospital and department to obtain and convey vital information required to process accounts
- Assist patients and members of the community with completing applications for public health programs such as MassHealth, Connector Care, and Health Safety Net via the CAC Assister Portal, or SACA via paper application, or Medical Hardship via the iNet website/paper application. Ensures patient follow through with enrollment process.
- Ensures compliance with the application process by obtaining and submitting appropriate confidential documentation to maintain eligibility.
- Analyzes incoming mail to determine appropriate action needed to resolve issues enclosed
- Supports patients with financial assistance for state/government programs by completing/submitting applications on behalf of the patient, compiling requested verification documentation, and coordinating with case workers for status
- Assists with post application health plan enrollment
- Meet with self-pay patients in-house to obtain health insurance information or assist with completing an application for public health programs.
- Provides outreach to discharged self pay patients by placing telephone calls and/or mailing letters to them in order to obtain insurance information, or to offer assistance to those uninsured
- Facilitates patient understanding of health access options including eligibility rules, coverage types, products and plans available, and educating enrollees on their rights and responsibilities
- Verify and add health insurance to patient’s accounts in the EHR to ensure proper billing.
- Add low income adjustments on old accounts for patient’s newly eligible for Masshealth.
- Refers patients to Shine, Social Security, Vet. Admin, Health Care, WIC or other financial resources as deemed appropriate
- Maintains knowledge of state and federal medical benefit programs and income guidelines as well as available community resources; discerns patients’ needs and provides information and referrals to other resources as necessary
- Attends MTF and other meetings, conference calls and education workshops to maintain knowledge of, and remain up to date with the latest changes under the Affordable Care Act.
- Maintains records for tracking statistics and compiles statistics as needed or requested
- Attends related agency meetings, training and educational workshops.
- Reports to supervisor, patterns of problems on patient accounts.
- Promotes positive relationships while maintaining professional conduct at all times, including relationships with patients, health care providers and interdepartmental personnel.
- Exhibits commitment and personal growth in his/her role by demonstrating the philosophies and standards of the PFS department and the mission and goals of Heywood Healthcare Systems.
Statement of Other Duties:
This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described.
Functional Demands
Physical Requirements:
Exerts up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), and handles (seizing, holding, grasping, turning, or working with hands).
