Financial Counselor

About the role

A Financial counselor serves as the liaison between the patient and the practice by coordinating payments, assistance, monitoring patient balances, and streamlining communication of the financial responsibilities of our patients. Performs the quality control function for pre-certification and prior authorization. The Financial Counselor ensures the patients’ insurance benefits are kept up to date in the electronic medical records (EMR) and billing software while also verifying the patient’s services meet insurance coverage appropriateness.

Responsibilities

• Monitors and coordinates internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals, seeking support from provider or pharmacy team when applicable.
• Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to establish patient financial responsibility.
• Review patients’ treatment plan(s) and identify if insurance benefit coverage is active and patient fiscal responsibility, all unplanned exceptions are to be communicated to provider immediately.
• Review and identify new treatment orders, generate an estimate of service and review with patient explaining insurance benefits and fiscal responsibility.
• If applicable, obtain necessary information from patient for assistance income guidelines.
• Identify and review patient ageing balances and establish proper arrangements with the patient to address outstanding balance(s).
• Discuss and explain forms and paperwork needed such as waivers, treatment estimates, payment plans, assistance applications, etc.
• Communicate openly and routinely throughout the course of the workday with providers, nursing staff, PSS staff, UM team and coworkers through Teams, phone calls, emails and in person to discuss fiscal responsibility and other items as needed.
• Work closely with outside entities to ensure full collaboration and completion of forms and items needed in a timely and sometimes urgent manner.
• Assist patient(s) with completing necessary paperwork for assistance and other grant funded programs in order to secure financial aid for treatment and services.
• Have an understanding of patient assistance programs and grant services processes to ensure adequate application, placement, and coordination with financial aid counseling team.
• Understand and comply with all Federal and State laws and regulations pertaining to patient care, rights,