Financial Case Manager - Senior

The Financial Case Manager - Senior is responsible for reviewing uninsured and under-insured patient accounts by following the insurance verification process.

Community/Acute - The FCM - Senior will assist under-insured patients by screening for secondary coverage options, applying for financial assistance and other government based programs. This person will work closely with Patient Financial Services to help resolve coordination of benefits (COB) issues.

STATUS: Full time

LOCATION: Riedman Campus / Seneca Ridge Dialysis

DEPARTMENT: Financial Assistance

SCHEDULE: M-F 8:00 AM - 5:00 PM

Key Responsibilities:

Financial Counseling
• Assesses the healthcare coverage needs of uninsured and under-insured patients.
• Verifies insurance coverage to identify uninsured patients who may be eligible for insurance enrollment, and provides the FCM II accurate information for patient interview when needed.
• Assists under-insured patients with applying for secondary coverage, in acute setting financial assistance applications and other programs in which they be eligible.
• Complete all financial and secondary insurance applications with high quality work, gathers all necessary documentation and submit them to the proper agency / staff for processing.
• Notifies the appropriate staff of pertinent information and enters notes into both the financial and clinical sections of the electronic health record in a timely manner.
• Thorough knowledge of long term care Medicaid program including necessary forms, documentation requirements, agency regulations and budgeting procedures for Long Term Care arena.
• Follows documentation and productivity standards according to policies and procedures.
• Assists patients with resolving non-complex coordination of benefit issues. May need to contact third party insurance providers to rectify primary and secondary coverage errors.
• Scanning and saving applications and decisions into system for future reference
• Track Private Pay residents in Long Term Care setting in order to begin Medicaid application at opportune time as to ensure no gap in coverage for nursing home.

• Additional duties as assigned with a positive attitude

Float between all hospital and long-term care settings when needed
- Covers complex settings such as Inpatient including HINNs, Emergency or Specialty care arenas
- Assists with additional projects above Medicaid enrollment such as complex coordination of benefit concerns, billing projects and involvement with new project builds.
- Shares expert public benefit knowledge with operational and clinical staff to assist with discharge planning and maximize patient coverage options, for example Social Security disability options.
- Attend and representing Long Term Care at legal fair hearings at Local Department of Health of Human Services courts.
- Work directly with system and resident’s attorney office while pursuing Long Term Care Medicaid approvals

Minimum Qualifications:

• Associates Degree in related field with four years of experience preferred or an equivalent combination of work experience in financial counseling, long term care setting, healthcare billing or customer/patient service is required.
• Three or more years of Medicaid enrollment experience required.

Licensure/Certification Requirements:
None