Outpatient Financial Counselor Quincy - 24 Hours M-W 8:30AM-5P U

Position Summary Under the general direction of PFC Manager, the Quincy Outpatient Financial Counselor (OPFC) has a dual role to help vulnerable BMC patients to access healthcare coverage and to preserve and protect BMC revenue by securing payors to reduce uncompensated care. The Quincy OPFC serves as an advocate and navigator, assisting low-income, uninsured and underinsured patients apply for financial assistance programs and secure healthcare coverage. As a Certified Application Counselor, the Quincy OPFC will respond to call center inquires and manage self-pay patient work ques to identify and contact patients in need of financial counseling services. The Quincy OPFC will engage patients, by phone and/or in writing, to screen for eligibility and provide enrollment assistance to secure insurance coverage through MassHealth, Out of State Medicaid, HSN, or BMC’s Charity Care Program. The Quincy OPFC is responsible for initiating new applications and assisting with program renewals; for educating patients about health insurance options and eligibility requirements; and for updating patient demographic information, opening financial trackers, and documenting all efforts made to assist patients in applying for insurance coverage. The Quincy OPFC will embody BMC’s mission, vision, and values and follow policy and procedure regarding BMC’s billing and collection practices and the Certified Application Counselor Designation Agreement between BMC and MassHealth. Position: Outpatient Financial Counselor Quincy Department: Financial Counseling Schedule: Part Time, 24 Hours M-W 8:30AM-5P U Essential Responsibilities / Duties

• Demonstrates respectful personal conduct and utilizes AIDET when engaging patients and visitors.
• Completes MassHealth’s curriculum for Certified Application Counselor and renews certification annually.
• Provides information about the full range of medical and dental insurance programs available through the Health Insurance Exchange (HIX).
• Interviews patients, in a language and manner best understood, to determine eligibility and communicate enrollment options and plan benefits for which patients qualify. Answers questions about Qualified Health Plans (QHP) and Qualified Dental Plans (QDP). Explains subsidized Qualified Health Plans available through premium tax credits or informs patients of expected out-of-pocket expenses, co-pays, and deductibles when applicable.
• Utilizes protected software programs to determine patient eligibility for MassHealth, Health Safety Net, ConnectorCare, and other insurance carriers and assists with enrollment process.
• Initiates communication with patients, by phone, mail, or email, , to initiate new applications or plan renewals for health insurance coverage. Informs patients of important deadlines, effective dates for coverage, and required documentation to determine eligibility.
• Scans MassHealth applications and supporting verification documents into HIX and patients’ Epic record.
• Documents in Epic the status of all applications initiated by adding a financial tracker and recording actions taken and follow-up efforts required to complete and submit for processing.
• As requested, assists patients with enrolling in an ACO or changing selection of ACO, to ensure continued access to covered services.
• Provides voter registration information and registration assistance as needed; completes appropriate patient declination form for applicants as requested.
• Validates and updates active insurance coverage in the hospital registration and billing system on accounts with covered dates of service.
• Assists patients with billing questions or concerns. For patients deemed ineligible for financial assistance programs, provides information regarding self-pay discount and payment plan options.
• Collects and posts payments for balances related to self-pay, Ad-Hoc, and Flat Fee contracts in accordance with BMC policy and procedure for collection practices.
• Interacts with numerous departments to resolve insurance and billing questions e.g., Customer Service, Pharmacy, Social Service, Case Management, Patient Accounts ,Clinic Staff, Unit Nursing staff, professional billing etc.
• Provides pricing estimates for elective services, as requested, if patient is uninsured or if services are uncovered by payor.
• Understands and adheres to rules established by the BMC Credit and Collection Policy.
• Assists patients with confidential applications for protected services, adding account notes to notify others of the patient’s protected status.
• Assists patients with medical hardship and confidential applications, obtaining and submitting verification documents and applicable medical bills required to apply and make a determination of e

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