Senior Resource Counseling Associate

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an 'owner' of Genesis and keep our patients at the center of everything we do - always.

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Department:

Financial and Revenue Cycle Administration

Overview of Position:

The Senior Resource Counseling Associate is responsible for meeting with patients/guarantors, who require assistance in seeking and applying for healthcare funding (e.g., Charity Care, Medicaid, or other local/governmental funding program) and/or require assistance in reviewing and establishing payment options.; The incumbent works with patients beginning with the initial patient contact, via the pre-admit/pre-registration functions, and ending with the control and maintenance of the patient's account.;

1. Functions as financial counselor for multiple patient types throughout the hospital for inpatient and outpatient activities.
2. Communicates with patients, family members/guarantors, 3rd party payers, local/governmental agencies, attorneys, employers, physicians/office staff and contracted vendors/agencies and various internal staff in the deployment of key activities.
3. Monitors reservation and scheduling information to initiate the financial counseling process on a pre-service, time-of-service and post-service basis. May interview patient and/or their representative either by telephone or in person to accurately update demographic, clinical, financial and insurance data. Reviews prior account notes for any information that might aid in the application/payment process, as well as documents all encounters and actions.
4. Ensures that all accounts are properly classified in the patient accounting system. Self-pay (uninsured) accounts will be screened within 24 hours of service, or next business day, with focus on high dollar accounts; high dollar patient liabilities, including outstanding balances; and under-insured accounts will be screened upon identification or upon patient/guarantor request.
5. Informs patient/guarantor of their liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances. May calculate patient liabilities and conduct credit scoring and propensity to pay modeling in order to determine their ability to pay for services. Provides financial education and outlines potential funding options, as appropriate. Documents payments/actions in the patient accounting system and provides the patient with a payment receipt.
6. Seeks appropriate funding based upon patient requirements, collecting supporting documentation as required. Provides information and education to the patient and/or family member of the application process. Encourages patient participation in the application process and assists the patient in forwarding the required documentation and application to the appropriate funding agency.
7. Follows up on eligibility applications status and provides appeal assistance, as appropriate. Follows up on the collection of payments from settlements, payment arrangements, out-of-network settlements, and specialty services (e.g., cosmetic, worker's compensation, auto accident, etc.) and determines course of action for non-cooperative patients (e.g., collections placement).
8. Investigates No Fault and Workers' Compensation cases, retrieving police report and insurance information, as required
9. Works with contracted vendors/agencies to qualify applicants, reviewing each case prior to agency placement. Obtains and distributes accounts for litigation, credit consolidation, tax purposes, bad debt recovery, etc. May meet with the contracted vendors/agencies to discuss policies, procedures and pending issues; maintains statistics of vendors/agencies' outcomes. May write-off accounts based on Genesis guidelines.
10. Assists staff in other departments including: Social Work Services in establishing Medicaid pending cases for placement in long-term care facilities or home healthcare, and UR/Case Management in documenting clinical information and soliciting assistance in clinical documentation from the medical staff.
11. Assists in identifying and obtaining funding for additional services required after discharge, establishing ongoing continuity of care counseling, and in discussing potential options for postponing or rescheduling care until funding is obtained.
12. May prepare special reports as directed by the manager to document utilization of the financial counseling unit's services and patient flow.
13. May assist other department personnel, as the work schedule or workload allows. Cross-trains in various functions to assist in the smooth delivery of departmental services.
14. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Genesis organizational integrity program, standards of conduct, as well as adherence to other policies and procedures to ensure honest, ethical, and professional behavior.
15. May serve as a notary public, notarizing documents for patients, physicians and other personnel.
16. Other duties as needed and assigned by the manager.

1. High school diploma or equivalent.
2. At least two (2) years prior work experience within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling, financial clearance and/or customer service activities is required.
3. Knowledge of insurance and governmental programs, regulations and application processes (e.g., Medicare, Medicaid, Social Security Disability, Tricare, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is required.
4. Must have working knowledge of medical terminology and basic computer skills.
5. Must have a thorough knowledge of the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account, based on information obtained from the patient/family.
6. Excellent verbal and written communication skills. Excellent Interpersonal skills in dealing with peers, internal and external customers.
7. Must be able to develop positive relationships with clinical staff to maximize effectiveness of the financial counseling function.
8. Accuracy, attentiveness to detail and time management skills are required.
9. Must be comfortable operating in a collaborative, shared leadership environment.
10. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring.

1. Living the Genesis Mission, Vision and Values

• Performs work in a manner that is quality focused.

• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.

• Results oriented and focused on achievement of objectives.

• Acknowledges and responds to the diversity of people and the situation.

• Encourages peers (others) to be owners of change.

• Always makes the effort to anticipate and exceed customer needs and expectations.

• Possesses the ability to engage others with patience and understanding.

• Acts in a manner that creates positive first and lasting impressions.

• Demonstrates the ability to own issues until they are resolved.

1. Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)

• Introduces self and role...connects with everyone.

• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.

• Asks for and anticipates needs and concerns of others.

• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)

• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.

• Responds to requests in an appropriate and timely manner.

• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.

1. Promotes Patient and Employee Safety

• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.).

• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.).

• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment.

• Demonstrates Slips/Trips and Falls Awareness.

• Actively contributes to maintaining a safe, clean and quiet environment.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Position operates in an office environment. Work area is well-lit, temperature controlled and free from hazards. May be subject to eye-strain due to the many hours spent looking at a CRT screen. The noise level is low to moderate. Must be able to sit for extended periods of time.
2. Occupational exposure to blood or other potentially infectious materials may reasonably be anticipated.
3. Must have ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.
4. May travel to other floors and to centralized files. Answers telephone calls, uses personal computer and other business machines extensively. Bends, reaches, pushes and pulls file drawers to file records and reports.
5. Vision abilities required include up close vision, peripheral vision, depth perception and the ability to adjust focus.
6. May be required to periodically rotate shifts and regular days off. All system employees must be willing to work all shifts, extra hours, holidays and emergency shifts as required.

This description reflects in general terms the type and level of work performed. It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.