Eligibility Counselor

Job Summary

Provides professional eligibility screenings to self-paying patients. Establishes a bill liquidation method that is fair and equitable to the patient and to Lexington Medical Center (LMC). Provides patients with hospital procedure estimates upon request. Adheres to all policies and procedures set forth by Lexington Medical Center.

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 2 Years of experience in a healthcare, patient registration, or customer service setting. 
Substitutable Education & Experience (Optional): None.
Required Certifications/Licensure: None.
Required Training: Familiar with medical terminology and procedures;
 
Working knowledge of the Fair Debt Collection Act by accessing Credit Bureau information, 

Experience with PC’s and other office equipment;

Demonstrates appropriate communication of information to all ages and responds to all customers/patients requests and needs, i.e. Hearing impaired, language barriers, sensitivity to various disabilities, etc.

Essential Functions

• Review Financial Assistance Programs with all patients or their authorized representative in a professional manner and obtains identifying information.
• Remain current on guideline changes for all respective program policies and procedures.
• Follow up with all patient referrals, including patient walk-in's that are in need of financial assistance.
• Initiates appropriate counseling and screening for LMC's indigent and catastrophic programs. A special consideration has been established for uninsured OB patients and the Columbia Free Clinic. Determinations made based upon a thorough review of the household's income and assets owned.
• Responsible for thorough completion of daily work; inclusive of patient follow-up items and assigned work queues.
• Follows up on Self-pay accounts according to LMC policy and procedures. Contacts patients or authorized representatives as needed to resolve patient financial liability to LMC.
• Responsible for working knowledge of Commercial, Medicaid, Medicare, and third party payors.
• Calculates estimates for all hospital procedures and electronically keeps records of estimates provided.
• Respond to customer inquiries, complaints, and correspondence in a prompt and professional manner to conform to LMC’s Service Excellence guidelines and LMC’s corporate compliance.

Duties & Responsibilities

• Maintains a high level of confidentiality. Access to Equifax and County property records are essential for decision making and referrals to management.
• Responsible for requesting credit reports and completing a detailed analysis to determine program eligibility.
• Documents all activity (patient and/or responsible party related information on each account processed).
• Maintains an optimistic and professional image. Interacts with patients, visitors, peers, and management in a professional manner consistent with hospital policies and procedures.
• Responsible for meeting the productivity levels as defined by the critical elements specific to the job.
• Completes e-training modules and adheres to hospital compliance programs.
• Scan all pertinent patient applications with the knowledge of how to retrieve information when necessary.
• Responsible for large volumes of work that must be completed within a designated time frame.
• Performs all other duties as assigned.