Patient Financial Coordinator

CCRM - Houston, TX

Full-time

The Patient Financial Coordinator (PFC) performs a vital role on the Patient Care Team to coordinate the financial aspects of the patient’s care. Together with fellow team members, the PFC works toward creating a positive and memorable patient experience. The PFC ensures that patients are well educated about the financial and insurance aspects of their care, and that steps are taken by the practice to ensure that proper payment is received from the patient or the patient’s insurance company on a timely basis. The PFC serves as a resource to patients regarding financially-related matters such that they are accessible to patients for ongoing questions regarding this aspect of their care. This position reports directly to the Director of Patient Financial Services, with a dotted line to the local Practice Administrator.

CCRM is an industry leading pioneer in fertility science, research and advancement, offering access to national network of award-winning physicians, a full suite of fertility services, innovation technology and cutting edge labs. CCRM is currently comprised of eleven locations spanning the U.S. and Canada with growth planned for continued network development on a domestic and international basis.

ESSENTIAL FUNCTIONS:

  • Insurance verifications for all patients prior to the New Patient (NP) appointment and prior to the start of any treatment cycle.
  • Ensure insurance benefits have been input into the practice management system.
  • For patients that have a change in insurance during their course of care, reverify or cause to have reverified, the patient’s insurance, and input the result of same into the practice management system.
  • Ensure that insurance is attached on the chart level for all patients; for existing patients with a change in insurance, ensure that a change of insurance attachment on the chart level has been performed.
  • Meet with NP’s at their NP appointment and explain that the Financial Coordinator will be the patient’s primary point of contact for all financially-related matters during their course of care.
  • Review with NP’s the insurance coverage that exists in their insurance policy or policies, should the patient have primary and secondary coverage.
  • Explain to the patient the practice’s guidelines and policies for Patient Financial Services.
  • Address any discrepancies between the patient’s understanding of their insurance coverage and the benefits relayed to CCRM upon verification.
  • For each patient assigned to the team, know the pre-certification requirements of the patient’s insurance policy and payer.
  • Using system reports identify all instances where pre-certification is required of any general medical service, infertility diagnostic service, infertility treatment service, obstetrical care service, or any other service so specified by the patient’s insurance company.
  • Perform pre-certifications or pre-authorizations.
  • Determine patient responsibility amounts based on the pre-certification performed. Communicate with the patient via phone or secure portal messaging the patient responsibility amount to be paid in advance of the related procedure.
  • Ensure that written pre-authorization documentation is received, when such written documentation is required, in advance of the patient proceeding with care.
  • Through the use of specified reports, and through the communication with respective team members, identify patients who will be proceeding with ART care.
  • Meet with all such patients to provide an ART Financial Consult, explaining to the patients the expected coverage from their insurance company, if any, and the amount that will be patient responsibility.
  • Collect ART related patient responsibility amounts in accordance with Practice guidelines (e.g. two weeks before baseline).
  • Determine patients for whom funds have and have not been collected for ART care to ensure that the Primary Physician is consulted regarding any patient who is approaching the beginning of care but has not paid their patient responsibility.
  • Create, for Patient Account Representatives at check-out through the use of system alerts, ART collection and practice management system posting instructions for patients based on the allocation between insurance coverage and self-pay responsibility.
  • Perform IVF Audits for patients completing IVF treatment cycles
  • Post any resulting transactions required as a result of the audit’s outcome.
  • Run reports specified in the End of Day Balancing process, and perform balancing procedures to ensure that all amounts reconcile to supporting documentation and to posted bank deposits.
  • Participate in HIPAA and other training as required by the Company.
  • Serve as a Patient Advocate for patients when patients have difficulty navigating with their insurance company.
  • Serve as Backup to the Patient Account Representatives in their absence
  • Respond to all patient inquiries, via either phone, portal messaging or in person, regarding their account and insurance related matters.
  • Serve as a resource to Physicians, Nurses and Patient Care Coordinators regarding any possible impact insurance coverage limitations or requirements may have on the patient’s care plan.
  • Serve as a resource to Patient Account Representatives performing Financial Review, when questions arise regarding specific patient’s accounts.
  • Attend scheduled team meetings as an active and contributing participant in the Patient Care Team.
  • Engage in an iterative continuous improvement process to insure the effectiveness of the above set-forth policies, procedures, methodologies, and workflows. Make recommendations for adjustments where indicated to optimize efficiencies for staff and reliability of output for financial and operational reporting purposes, resulting in best-in-class practices and results.
  • Engage in a collaborative process with fellow colleagues to bring about the best possible experience for the patient.
  • Participate in and be an effective contributor in regular and ad-hoc meetings as necessary to achieve Practice and Corporate objectives.
  • Other duties as assigned.

POSITION REQUIREMENTS:

  • Minimum of High School Diploma or GED, required; Associate’s degree or Bachelor’s Degree preferred, or equivalent relevant professional work experience.
  • 1+ years of experience in a professional work environment. While a healthcare environment is desirable, it is not required.
  • Ability to work weekends, evenings and holidays, on a rotating basis with other teammates.
  • Strong proficiency with Microsoft Office programs, specifically Word, Excel, and Outlook.
  • Must enjoy serving patients and interacting with them.
  • Strong analytical skills and the ability to effectively read, generate and analyze reports.
  • Superior judgment and decision-making skills.
  • Strong ethics and a high level of personal and professional integrity.
  • Excellent customer service skills with high expectations to consistently delivery quick responses and provide an exceptional experience for all employees and managers.
  • Excellent interpersonal and communication skills, an outgoing personality, with a professional demeanor and positive attitude with the ability to communicate positively and professionally with patients and staff members at all levels.
  • Excellent written and verbal communications skills.
  • Strong attention to detail, excellent organizational skills and excellent multitasking abilities.
  • Exceptional personal and professional integrity and strong work ethics.
  • Demonstrated ability to be a team player and possess a willingness to perform duties that are assigned or delegated to him/her as well as a willingness to perform duties of other employees as needed.
  • Be a motivational force by exemplifying the company vision, mission, values, and culture.
  • Strong ability to maintain confidentiality and exercise discretion regarding confidential and sensitive information.
  • Exhibit courteous, compassionate and respectful treatment of internal and external customers. Displays a positive attitude and flexibility in changing situations.
  • Participate in identifying problems and suggesting solutions.

WORK ENVIRONMENT

This job operated in a professional office setting performing predominantly sedentary work. This role routinely uses standard office equipment such as computers, including computer keyboards and mice; telephones; photocopiers; scanners; filing cabinets. While performing the duties of this job, the employee is regularly required to talk, see and hear. The employee is frequently required to sit; will occasionally stand and/or walk; use hands and fingers to grasp, pick, pinch, type; and reach with hands and arms. Employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; viewing a computer terminal; extensive reading; operation of standard office machines and equipment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

EQUAL EMPLOYMENT/ANTI-DISCRIMINATION

CCRM is an equal opportunity employer and does not discriminate on the basis of Race, Color, Religion, Creed, National Origin, Ancestry, Sex, Pregnancy, Age, Sexual Orientation (including transgender status), Physical or Mental Disability, Marriage to a Co-Worker, or for anyone engaging in Protected Activity (opposing a discriminatory practice or participating in an employment discrimination proceeding). Additionally, this employer does not tolerate any employees engaging in discriminatory behavior based on any of the aforementioned protected classes.

PRE-EMPLOYMENT REQUIREMENTS

All offers of employment by this employer are conditional upon the incumbent’s successful completion of pre-employment screenings, including a criminal background check, drug screen, educational and prior employment verification, professional reference checks, and verification of the incumbent’s eligibility and authorization to work in the United States.

COMPENSATION & BENEFITS

CCRM proudly offers a competitive and comprehensive compensation and benefits package to full-time employees, which includes medical, dental, vision, life and disability insurance, and 401(k) with company match.

Job Type: Full-time

Experience:

  • professional work: 1 year (Preferred)

Education:

  • Bachelor's (Preferred)