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The Children's Hospital of Philadelphia Financial Counselor in Philadelphia, Pennsylvania

Reference #: 703750300Location:LOC_1300_MKT-Wanamaker BuildingReq ID:88576Shift: DaysEmployment Status:Regular - Full TimeJob SummaryThis is a position requiring professional phone skills, independent thinking, and advanced insurance/registration techniques. The Financial Counselor will be responsible for verification of insurance, detailed benefit collection and authorization processes for patients seeking care at CHOP. The Financial Counselor will handle verification of insurance, detailed benefit collection, and identification of covered and non-covered services, explanations of benefits structures, as well as necessary contact families, providers, and payors regarding: referral issues, authorizations, FHCC eligibility as well as a host of other insurance eligibility and authorizations of services issues. The Financial Counselor will cross cover other areas as needed.Job ResponsibilitiesCoverage ResponsibilitiesDemonstrates 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 policiesAuthorization issuesContract participationProcess for pre-cert/pre-auth of non covered servicesProvider ID numbers and CPT codes (if applicable)Verify coverage and benefit information via electronic eligibility or by contacting payor and documenting relevant information in EpicFollows up with insurance companies and families of patients identified as ineligible or non- coveredFollows up with insurance companies and families of patients identified as ineligible or non-coveredContacts family and/or responsible party, as necessary, to inform them of any 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.Assist with FHCC issues and Completes abbreviated assessment to determine family eligibility for Family Health Care Coverage programs.Educates families and clinical team regarding insurance coverage plans. Authorization responsibilitiesReview 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 necessityNotify 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.Stay abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy.Coordinates denials, complete retrospective review as needed, and inform physician office of denial.Refer self-pay patients to business office for payment options.Ability to convert common diagnosis descriptions to numeric ICD 9 or CPT code.Creates templates with correct CPT Codes for specific services for Single Case Agreement Registration ResponsibilitiesUpdate patient registration as needed, specifically demographics and insurance informationEnsure specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payor plan entries for research and standard-of-care visitsVerify coverage through payor portals and pull appropriate referrals as needed.Coordinate and communica