Financial Counselor

Financial Counselor

About Us

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, MGB supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

GENERAL OVERVIEW

The Financial Counselor (FC) is responsible for greeting and interviewing patients and families seeking financial assistance within McLean Hospital, while supporting McLean Hospital admissions flow for patients referred from multiple sources. Performed in a manner which contributes to a customer-service oriented and patient-centered healthcare environment, the FC is accountable for making independent decisions on scope of financial risk for all admissions needing financial clearance due to limited or lack on insurance coverage. The FC will be responsible to ensure patients with limited resources have access to and that reimbursement is adequate for services provided. The FC will coordinate the MassHealth application and conversion process and is responsible for thorough follow-through and relationship maintenance with both external and internal parties. Responsible for the in-depth and detailed evaluation, continued updates and maintenance of a patient’s demographic information and financial history for both uninsured and under-insured patients, for the purpose of determining eligibility for healthcare-related benefit programs. The FC ensures the facility information systems and program applications remain current reflecting most recent financial class or patient case status. The FC works collaboratively with Admitting, Case Management, Social Work, Patient Accounts, Financial Access Specialists (FAS) and Leadership staff to ensure any patient flowing through the referral to admit to discharge process, has sufficient coverage and the facility receives appropriate reimbursement.

PRINCIPAL DUTIES AND RESPONSIBILITY

• Works independently with high-volume, time-sensitive patient cases as part of a combined effort with Case Managers, Social Workers, State Workers, Patient Accounts, Admitting and Financial Access Staff to resolve patient issues including, access, billing, and discharge barriers.

• Conducts financial assessments for public benefits including but not limited to: MassHealth, Health Safety Net, Connector Care, Careplus, MCR D and Family Assistance; Offers Medigap insurance choices for patients not qualified for MassHealth or government assistance programs. Coordinates benefits between state programs and private insurances.

• Determines most appropriate form of financial assistance for patient and assists patient and/or patient representative in insurance program application submission, approval, and enrollment processes, acting as patient representative to State agencies.

• Understands deductibles and spend downs; what can and cannot be used to reduce income and/or assets; MassHealth look back requirements set by state, how to determine if patients/families should seek legal counsel for financial assistance; responsible for communication of all to patients and families.

• Initiates and completes applications for purpose of providing patients access to state and federal medical services for discharge planning needs/proper placement of patients to ensure appropriate reimbursement received from payer sources. Works within particular criteria for approval, as specific course of action is designed to address patients’ individual needs (ie. upgrade from Community Medicaid, Disability Applications, Standard approval, etc).

• Review and maintenance of daily batch eligibility reports requiring identification of in-house patients needing Medicaid; ensures SC1 forms are completed and sent to MassHealth office; works to resolve any ineligible patients identified on list

• Maintains accurate electronic documents and files appropriately to assure regulatory compliance. Responsible for documentation of follow-up attempts made, each step or interaction with patient or representative, whether verbal, electronic or face to face to keep cases reflecting most recent status.

• Ensures patient data and all required documentation are collected accurately and timely; responsible for consistent follow-up on applications and supplements until required documentation has been received, submitted and final determination made.

• Proactively collaborates with Patient Accounts and FAS, Team Lead and Director, to identify and resolve payment source issues that arise; exemplifies ability to make sound decisions and have keen sense to alert Leadership of financial risks requiring additional efforts and involvement for resolution. Contributes to process improvement initiatives by providing ideas, feedback and best practice suggestions.

• Remains familiar and updated with Government, Affordable Care Act (ACA) and Managed Care Organization (MCO) payment regulations; attends MassHealth Training Forums (MTF) Seminars and other trainings offered by MGB and State regarding upcoming changes and implementation of new rules within the evolving Healthcare System; mandatory trainings and/or educational professional development seminars per discretion of Senior Manager of Patient Access.

• May assist with preparation of Private Pay Financial Proposals; communicates deposit estimate amounts, collects cash and payment arrangement options to appropriate parties. Carefully chooses and executes appropriate workflow process as it relates to each individual patient scenario; acts as liaison with Business Office on payment plans.

• Expert resource to Billing Office Supervisor with billing issues for MassHealth claims and resolving denials; weekly required attendee on entity underinsured/problem case calls; Answers help line inquires and assists patients and families with public benefits, other insurance programs, and MassHealth billing matters.

• Understands role of PHS Legal Council, office staff and resources available; familiar with instances in which Attorney involvement and follow-up becomes necessary; attends MassHealth Appeals Board Hearing as representation for SRH

• Responsible for promoting positive customer service and developing and maintaining positive relationships with all referral sources, state and government agencies, insurance companies and patients/families. Contributes to a positive facility experience for patients and families through courteous greeting and interview activities, and routing them to other facility staff when appropriate; is HIPPA compliant; adheres to department and Federal regulations regarding patient confidentiality at all times.

• Completes additional tasks as assigned by team leaders, supervisors and/or managers.

High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred

Experience in customer service related role preferred

Experience with medical terminology and hospital ADT system preferred

Knowledge/working experience with state-sponsored programs, managed care and government plans

Experience in hospital Admissions, registration or insurance billing preferred

Knowledge of insurance plan’s requirements and procedure

CAC (Certified Application Counselor) Certification preferred, not required

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED

• Ability to work independently in a fast paced environment; retain State and department policies and regulations, and quickly incorporate them into daily financial counseling activities.

• Excellent written, and oral communication skills; must communicate effectively in a sensitive manner with team, patients and facility staff.

• Requires professional service-oriented individual with strong organizational skills, good judgment, diplomacy, and independent thinking as the work environment at times can be pressured and stressful.

• Must hold critical thinking skills and be capable of analyzing situations, prioritizing multiple tasks, re-prioritizing, making decisions under pressure and meeting tight deadlines in a fast-paced environment.

• Able to provide superb customer service, build and maintain positive working relations with facility staff and State workers.

• Ability to travel between SRN sites when necessary.

• Must be cooperative, flexible, and adaptable to change to meet department goals and mission.

• Must have a positive attitude towards working in a team environment and always take the initiative to help others as needed.

• Attention to detail, consistently.

• Has adequate typing skills, 30 wpm required.

• Familiar with computers and Windows applications such as Outlook, Word, and Excel.

• Bilingual in English and another language, a plus.

Mass General Brigham is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.