Certified Application Counselor (U)

Position: Certified Application Counselor - BMC

Department: Financial Counseling

Schedule: Full Time

POSITION SUMMARY:

The Certified Application Counselor, (CAC), is responsible for helping low-income, self-pay patients enroll in health insurance coverage ensure patients' access to timely and necessary medical care and secure payment for services provided by the health system. The CAC will assist patients in completing and submitting applications for financial assistance, including obtaining required documents and providing follow-up as need. The CAC will also assist with coverage renewals or request for plan changes. CAC will be will engage patients, by phone and/or in writing, to screen for eligibility and provide enrollment assistance in MassHealth, Out of State Medicaid, HSN, or BMC's Charity Care Program. Additionally, the CAC will be responsible for educating patients about health insurance options and eligibility requirements.

JOB REQUIREMENTS

EDUCATION:

High School diploma required, College degree preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Individual must receive training and be certified as a Certified Application Counselor within 45 days of employment.

EXPERIENCE:

Minimum of two years of Customer Service experience or equivalent combination of education and experience.

KNOWLEDGE AND SKILLS:

• Must be extremely organized, able to appropriately prioritize, to make independent decisions, and must have strong problem resolution skills and the ability to manage a heavy caseload of patients.
• Must demonstrate computer competency with use of keyboard and mouse and must demonstrate excellent customer service skills.
• Candidates who are bilingual and who have hospital experience are strongly preferred.

ESSENTIAL RESPONSIBILITIES / DUTIES:

• 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.
• 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 eligibility.
• Responds to telephone calls in a courteous manner. Responds promptly to all inquiries from staff, patients, and general public. As needed, refers callers to other departments or resources deemed appropriate for resolution.
• Presents and interacts respectfully and professionally with BMC patients, visitors, and other team members; works cooperatively and respectfully with other departments and disciplines across the organization.
• Maintains daily written reports of work activity to document patient enrollments and outcomes; patient complaints and resolutions; patient declination, etc.
• Demonstrates superior customer service standards.
• Participates in regular staff meetings and scheduled training to maintain required core competencies.
• Serves as a resource and subject matter expert regarding financial assistance programs. Provides education and advisement on health insurance options and enrollment requirements for other hospital departments, community health centers, community leaders and other personnel as needed.
• Under the direction of PFC Manager, assists with the orientation, including shadowing of new staff as assigned.
• Validates and/or updates demographic and income information in HIX portal for "known" patients with prior history of program eligibility.
• Validates patients' active insurance coverage and updates current plans in Epic.
• Conducts patient follow-up on pending applications to ensure that required documents are obtained and applications are completed and submitted timely to secure retroactive coverage.
• Protects patient and family confidentiality. IND123

Equal Opportunity Employer/Disabled/Veterans