FINANCIAL COUNSELING

Job Description Summary

Under the direction of Patient Access Manager is responsible to assist in maintaining the financial integrity of South Shore Hospital through excellent customer service skills. Advocate and screen patients for the procurement benefits through state public assistance programs. Ability to interpret commercial and federal insurance plan coverage for patient and families. Responsible for the determination and collection of medical co-pays at the time of service.

Job Description

Essential Functions

1. Education of financial obligations and polices to patient and or family members.

a. Collect co-pays via cash, check, credit card, complete receipts.Can reconcile and balance receipts by shift. Able to log into excel spreadsheet and documents on patients account.

b. Able to procure and explaining estimated pricing for outpatient hospital services (i.e. Cat Scan, MRI, Ultrasound, )

c. Able to promote and support SSHOSP self pay payment process (reviewing discounts and payment plan processes)


2. Contacts all self pay patients whether in person or via phone/letter to screen for eligibility for Financial Assistance within time frame established.

3. Demonstrates working knowledge of all public assistance programs and is able to screen patients for eligibility for these programs and initiate application.

a. Ensures application is completed by effective communication with patient is able to work collaboratively with co-workers and others (i.e. MEC, other facilities, and other departments) in order to complete the application with in time limitations.

b. Able to collaborate with social work and case management areas for patient care


4. Is able to update registration information as necessary.

5. Understand coordination of benefits and acts as a liaison between patients,Case Management, Patient Accounts Department, and Precertification.

6. Embraces Technology solutions to work processes and practices.

a. Able to function using department computer programs (Gateway, Excel, Word).

b. Able to review and analyze MMIS and Passport Programs.

c. Manage own API (timecard) system.

d. Able to utilize the phone system, including VERA system.

e. Has a complete understanding and can manage credit card processes in Passport system (ie. process of payment, refunds).

f. Able to function and have a complete understanding of computer downtime process.


7. Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment.

a. Understands individual roles/responsibilities during hospital codes (e.g. Code Green, Code Red)

b. Adheres to universal precautions and respiratory etiquette guidelines.

c. Adheres to patient identification policies/procedures.

d. NIMS 100 certified

e. Able to identify correct insurance subscriber

f. Understand roles in emergency preparedness


8. Strong working knowledge of State and federal disability processes and regulations.

Essential Functions (Cont.)

I. Technology and Learning

a. Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.

b. Embraces technological advances that allow us to communicate information effectively and efficiently based on role.

Unit/ Department Specific Job Functions

Unit Specific functions are those tasks, duties and responsibilities that are specific to the performance of the job within a certain unit(s). Following are unit specific functions of the job, along with the corresponding performance standards.

1. Strong working knowledge of the Virtual Gateway system.

a. Able to navigate and process application.

b. Ability to complete the application with patient and their families.

c. Ensure all information and supports gathered for application are processed.

2. Understanding and ability to identify patients that need state disability supplements completed.

a. Once identified initiate and submit DDU supplement, following it to completion.


3. Recognize and direct patients through the Federal Social Security disability process.

4. Working knowledge of State Unemployment insurance regulation. Ability to complete and submit these application.

5. Ability to recognize and advocate for patients who meet the criteria for state sponsored insurance premium assistance program.

6. Exemplary understanding of State sponsored insurance program.

a. Able to advocate for patients through the state to ensure appropriate level of assistance is awarded.

7. Direct knowledge of State and Federal sponsored programs such as SNAP, WIC, DTA, and Social Security. Ability to direct patients to these agencies.

Excellent customer service skills. Medical terminology. Computer skills. Ability to follow through and troubleshoot. Attention to detail. Strong organizational and documentation skills. Indepth knowledge of insurance plans including Masshealth , Commercial insurance, and State and Federal insurance programs Understanding of State and Federal Healthcare Reform