Financial Counselor

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Seeking Breakthrough Makers

Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview

This role requires strong professional phone presence, independent judgment, and advanced knowledge of insurance and registration processes. The Financial Counselor is responsible for comprehensive insurance verification, financial assistance assessments, and detailed benefit collection and authorization processes for patients seeking care at CHOP.

• Responsible benefit detail and authorizing the services
• Demonstrates an understanding and provides information of benefit structures to patients, physicians, and hospital practices as well as provides information on the following areas:
• Hospital prompt pay and payment plan policies
• Authorization issues
• Contract participation
• Process for pre-cert/pre-auth of non covered services
• Provider ID numbers & CPT codes (if applicable)
• Verify coverage & benefit information via electronic eligibility or by contacting payor and documenting relevant information in Epic
• Follows up with insurance companies and families of patients identified as ineligible or non-covered
• Contacts family and/or responsible party, as necessary, to inform them of any financial assistance or insurance applications statuses, insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party. Contact clinical office with all information that requires follow-up.
• Support financial assistance assessment and/or insurance applications to obtain coverage as needed.
• Responsible for review, vetting, and dissemination of all Philadelphia Health Center Referrals, and Community Partner referrals received by Department
• Educates families and clinical team regarding insurance coverage plans.
• Stay abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy.
• Leverages benefit collection information and Epic tools to clear services and create estimates for services
• Respond to emails, answer calls, provide explanation of covered and non-covered services
• Contacts appropriate clinical staff in timely manner with all information that requires follow-up.
• Authorization responsibilities
• Review diagnosis/procedure codes to ensure they are documented correctly and accurately reflect the clinical information and services to be performed.
• Discuss and send pertinent medical history to complete authorization process.
• Discuss, interpret and send pertinent medical history to complete authorization process (inclusive of pre-determinations).
• Work on complex medical cases that are in pending status until cases are complete and works with clinical teams for additional clinical information and/or a letter of medical necessity.
• Notify physician office/hospital of coverage issues, denials due to procedures not medically necessary, or if insurance carrier requires additional clinical information and/or peer to peer requests.
• Prioritize daily requests based on date of service, insurance carrier requirements, unexpected date changes or urgent requests, while processing request within department standards.
• Coordinates appeals or retrospective review as needed following up on payor denials
• Ability to convert common diagnosis descriptions to numeric ICD 9 or CPT code.
• Partner with specialist to outline correct CPT Codes, NPI, and authorization details for specific services for Single Case Agreement

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Preferred

Experience Qualifications

• Background in medical terminology Preferred
• EPIC registration Preferred
• Resource scheduling experience (i.e. ancillary testing) Preferred

Skills and Abilities

• Medical Insurance background
• Strong customer service experience
• Ability to work with stressful situations
• Ability to function efficiently and professionally with minimum of supervision.
• Ability to quickly learn new procedures.
• Strong computer skills.
• Ability to juggle multiple insurance issues.
• Strong customer service skills
• Ability to display compassion and empathy
• Mandatory required training within first 30 days:
• ACD Software Training
• Website Insurance Training (Navinet, WebMD, Passport)
• EPIC training & testing (Prelude/Cadence).
• Registration Essentials
• Cardiac Center databases

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.