Job Description

Serves as primary resource in assisting and determining financial assistance opportunities for BTNRH patients and families prior to, throughout and following their care delivery. Assists patients, parents and/or guardians in understanding their financial obligations and exploring the situational appropriate financial options, such as providing care estimation, financial assistance, payment plans and enrollment for Government agency healthcare programs. Performs final notice pre-collection calls in an attempt to minimize referral to our external collection agency, offer financial assistance not previously identified and as appropriate screens for Medicaid eligibility. Receives and handles all bankruptcy notices to ensure we stay compliant with all pertinent laws and regulations. Serves as the Revenue Cycle liaison with our collection agency regarding presumptive charity and settlements.

MAJOR RESPONSIBILITIES & DUTIES:

Assists patients and/or guardians in determining an estimate for cost of services to be rendered by conducting a financial screening and anticipates out of pocket liability including: co-payments, coinsurance, deductible, and non-covered or self-pay service charges prior to their visit or rendering of service by utilizing resources which may include but are not limited to; payor websites, employer benefit departments, servicing provider representative, internal electronic medical record and charging source systems.

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Communicates and collects estimated out of pocket liabilities in advance of services and/or counsels appropriate party with options available to assist them via enrolling in governmental programs, setting up payment plans, and/or completing the full application process for BTNRH Financial Assistance, depending on current income levels, lifetime max benefit levels, and any catastrophic medical needs or services rendered. Screens for potential secondary Medicaid eligibility in instances where there is high patient out of pocket that Medicaid may pay on.

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Screens and assists patients in completing NE Medicaid or independent state agency Medicaid applications and provides aid in ensuring the proper documentation for approval of their application is obtained and submitted to agency officials. Applications may be made through various programs such as MHCP, Emergency Alien Medical Program, and various waiver program applications.

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Works all COB denials from Medicaid & Managed Care Medicaid, contacting the patient &/or guardian to identify whether other commercial coverage is active, gathering all pertinent information, updating Epic and ensuring new primary claims are submitted in the correct filing order.

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Completes all pre-collection calls in an effort to assist the patient in determining an acceptable payment plan, if they qualify for financial assistance &/or eligibility for Medicaid/Government agency healthcare programs and minimizing outsourcing A/R to our 3rd party collection agency.

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Reviews all bankruptcy notices and handles all necessary adjustments to ensure we are complaint with all existing bankruptcy laws & regulations.

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Reviews clinic schedules to determine opportunities regarding no coverage, potential high dollar visits or new patients missing necessary insurance information that can be obtained prior to the date of visit and services rendered.

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Refers patients to appropriate SSI office to apply for disability when conditions warrant this type of assistance.

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Maintains summary data to report quarterly, or as needed, to re-cap activities, time, and expenses related to filing financial assistance applications, Medicaid application processing, community resource referrals CHIPS, COBRA benefit reviews, and collection efforts.

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Serves as a liaison between the patient, referral sources (e.g., Customer Service, Social work, Registration, Physicians, Hospital, and Ancillary service lines), BTNRH Patient Financial Services and clinical operations to explain charges and offer acceptable payment options and/or outside agency resources.

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Performs annual review and updating of policy and procedures relating to financial assistance guidelines and practices.

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Checks all pending Medicaid applications daily. At point of approval, reviews patient level encounters and account information, makes appropriate updates to coverage, alerts pre-certification and/or utilization review nursing team for any patients currently admitted or pending admission status and flags accounts for claims processing. For denied applications, determines cause of denial and determines eligibility for financial assistance or appropriate payment options.

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Performs a monthly check, during the first week of each month, of all in-house NE & IA Medicaid patients, as well as any scheduled surgeries in the current month, previously eligible for the prior month. Making appropriate updates to all affected systems, as well as providing updates to appropriate other parties as needed for billing, authorization and discharge planning purposes.

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Assists the patient with contacting insurance companies when questions arise concerning benefits, coverage, and payment liability for services, either proactively or with dispute of existing charges.

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Performs

proactive review of all self-pay accounts scheduled for services to be performed at BTNRH clinics and/or currently admitted to the facility that may involve potentially high dollar services or lengthened stays

prior to discharge.

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Acts as liaison between BTNRH and States of IA and NE departments of Health and Human Services to remain informed of policies and guidelines as well as changes and updates. Annually coordinates and attends on-site informational meeting with state representatives to update BTNRH on available programs available to the public, changes in procedures, policies and/or guidelines, and to address any questions/concerns staff may have regarding current policies and procedures.

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Provides timely communication updates to members of leadership, compliance and marketing as needed to ensure compliance and accuracy of marketing materials.

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Annually reviews and updates federal poverty guidelines based on federally driven standards.

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KNOWLEDGE, SKILLS, AND ABILITIES:

Ability to apply thorough knowledge of ICD-9-CM, HCPCS/CPT coding theory, medical terminology, disease process and anatomy/physiology, as they relate to patient services and liabilities.

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Ability to type 30 wpm and make arithmetic calculations with at least 90% accuracy.

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Ability to maintain current and accurate records, with meaningful summaries.

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Ability to treat information in patient records with strict confidentiality.

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Ability to communicate effectively, both written and orally, de-escalating stressful situations, while maintaining a positive and professional demeanor through all actions and communications.

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Ability to interpret insurance contracts and benefits.

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Ability to apply working knowledge of 1500 and UB04 billing.

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Excellent interpersonal skills, close attention to detail, critical thinking and organizational skills.

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REQUIRED QUALIFICATIONS:

High school diploma or equivalent required.

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Minimum of 5 years of experience in healthcare, with collections, follow-up or customer service focus

required.

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Knowledge of medical insurances (Medicare, Medicaid, PPO, HSA plans, and Commercial), EMTALA regulations, hospital and professional billing service and collection process required.

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PREFERRED QUALIFICATIONS:

Associates degree or post-secondary education in fields of Business, Healthcare, Finance or Customer Service preferred.

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Experience working in Electronic Medical Record preferred.

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Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.

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Serves as a role model in carrying out activities and behaviors that reflect the values and principles of the Boys Town mission.

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PHYSICAL REQUIREMENTS, EQUIPMENT USAGE, WORK ENVIRONMENT:

Position is relatively sedentary in a normal office administrative environment involving minimum exposure to physical risks. Will use office equipment such as a computer/laptop, monitor, keyboard, and a general workstation set-up.

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Care and respect for others is more than a commitment at Boys Town - it is the foundation of who we are and what we do.

At Boys Town, we cultivate a culture of belonging for all employees that respects their individual strengths, views, and experiences. We believe that our differences enable us to be a better team - one that makes better decisions, drives innovation, and delivers better business results.

About Boys Town:

Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.


Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities. A unique feature for employees and their dependents enrolled in medical benefits are reduced to no cost visits for services performed by a Boys Town provider at a Boys Town location. Additional costs savings for the employee and their dependents are found in our pharmacy benefits with low to zero-dollar co-pays on certain maintenance drugs. Boys Town takes your mental health seriously with no cost mental health visits to an in-network provider. We help our employees prepare for retirement with a generous match on their 401K or 401K Roth account. Additional benefits include tuition assistance, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.

This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.