FINANCIAL COUNSELOR

Responsibilities

• Advanced Insurance Verification & Revenue Integrity
• Multi-Payer Coverage Analytics
• Validate, interpret, and configure complex commercial, state, and federal insurance benefits within the Electronic Health Record (EHR) to prevent downstream denials and ensure optimal facility and professional reimbursement.
• Analyze inpatient and outpatient accounts for real-time insurance modifications, driving immediate updates to Utilization Management to secure timely authorizations and eliminate preventable clearinghouse or claim-edit rejections.
• Specialized Payer Navigation
• Investigate, secure, and manage high-complexity accounts, including Michigan Auto No-Fault (MACP), Workers' Compensation statutory rules, and Veteran’s Administration (VA) Care Acts, ensuring precise regulatory compliance and accurate primary/secondary payer formatting.
• Regulatory Pricing Compliance
• Conduct patient financial interviews to review, explain, and legally disclose complex hospital pricing structures and Good Faith Estimates (GFE) to patients in compliance with state and federal No Surprises Act mandates, while securing necessary pre-service payment arrangements.
• Concurrent Window & Workflow Management
• Efficiently staff the public-facing cashier’s window to process payments, inquiries, and applications while concurrently managing digital system work queues, insurance verifications, and desk workflows during intervals between face-to-face patient interactions.
• Account Eligibility & State/Federal Casework
• Serve as a certified MDHHS MI Bridges Navigator and Certified Application Counselor (CAC) for the Federal Funded Market Place (FFM), acting as an authorized institutional representative to execute Medicaid, Spend-down, and Federal Marketplace applications.
• Clinical Outreach & Case Resolution
• Conduct targeted clinical unit/bedside interventions to interview patients, capture critical financial data, resolve complex Coordination of Benefits (COB) conflicts, and process retroactive state medical assistance applications with strict supporting documentation.
• Payer Advocacy & Dispute Resolution
• Collaborate directly with MDHHS caseworkers, Federal Exchange supervisors, and insurance adjusters to expedite complex eligibility determinations and resolve enrollment barriers on behalf of the health system and the patient.
• Financial Counseling & Navigation
• Educate patients and families on complex healthcare financial structures (e.g., deductibles, coinsurance, self-pay liabilities, and institutional financial assistance programs) both via telephone and in person at the cashier's window to mitigate financial toxicity and resolve billing friction.
• Account History Review & Analysis
• Analyze complex account histories within Epic to interpret charges, payments, and insurance adjustments, translating intricate financial data into clear, understandable language for patients and families.
• Discrepancy Identification
• Investigate patient billing inquiries and coordination disputes to identify underlying system registration errors, eligibility mismatches, or inaccurate charge captures.
• Strategic Revenue Cycle Escalation
• Act as a front-line quality check by promptly escalating identified account discrepancies, system errors, or required adjustments to the appropriate Hospital/Professional Billers or Revenue Cycle leadership for formal correction.
• Cross-Departmental Financial Management
• Provide comprehensive institutional cashiering and banking support services, executing secure payment processing, balancing high-volume transactions, and logging deposits across multiple hospital departments into the corporate finance system.
• Patient & Departmental Deposit Processing
• Securely accept and process patient payments and departmental funds, ensuring all cash, checks, and credit transactions are meticulously documented and prepared for secure transport.
• Chain-of-Custody & Armored Transport Coordination
• Manage the preparation, documentation, and secure transfer of patient payments and departmental deposits to the Loomis armored truck company, strictly adhering to institutional security and verification protocols.
• Cash Management & Cash Operations
• Manage, dispense, and reconcile corporate Petty Cash reserves, execute formal banking change orders, and balance daily institutional deposits to ensure absolute financial accountability and internal control compliance.
• Manage specialized system work queues, correct demographic/guarantor mismatches, and maintain clean data integrity between patient access and central billing offices.

Qualifications

• Education & Experience
• Required: High School Diploma or GED.
• Required: Active Certified Application Counselor (CAC) certification (or ability to achieve within 90 days of hire).
• Required: Active MDHHS MI Bridges Navigator designation (or ability to achieve within 90 days of hire).
• Preferred: Associate degree in Healthcare Administration, Business, Finance, or a closely related field.
• Preferred: State of Michigan Notary Public Commission.
• Preferred: Certified Revenue Cycle Representative (CRCR) or Certified Patient Service Specialist (CPSS).
• Preferred: 2+ years of experience in specialized Hospital/Facility Patient Access, Professional Revenue Cycle Billing, or Advanced Healthcare Collections.
• Preferred: Demonstrated intermediate-to-advanced proficiency in Epic ADT, Epic Cash Drawer, Resolute Hospital Billing (HB), and Resolute Professional Billing (PB).
• Preferred: Completion of formal medical terminology, medical coding, or healthcare billing coursework.

Knowledge, Skills, And Abilities

• Advanced operational knowledge of complex healthcare regulations governing facility billing and access, including EMTALA, HIPAA, COBRA, the No Surprises Act, Medicare Secondary Payer (MSP) statutes, Red Flag Rules, Advanced Beneficiary Notices (ABN), and Michigan Auto No-Fault regulations.
• Technical Systems Proficiency
• Highly proficient in navigating complex enterprise Electronic Health Records (EHR) and integrated electronic eligibility/clearinghouse systems, alongside advanced utilization of Microsoft Office Suite (Word, Excel, Outlook).
• Strong mathematical and analytical skills required to interpret insurance contracts, calculate complex patient out-of-pocket liabilities, and reconcile multifaced financial ledgers/cash drawers.
• Dynamic Task Prioritization
• Demonstrated ability to work with high autonomy in a highly visible environment; must possess the strong organizational skills required to seamlessly shift between public-facing customer service (processing payments/applications) and detailed back-end revenue cycle workflows without compromising transaction accuracy or data integrity.
• Ability to maintain regular, predictable, and punctual attendance in accordance with ADA, FMLA, and organizational standards.
• Constant sitting, feeling, talking, hearing, and near vision.
• Frequent standing, walking, and midrange vision to facilitate clinical bedside navigation across diverse hospital units.
• Occasional lifting to 25 lbs., carrying, pushing, pulling, stooping, kneeling, or crouching during patient care area navigation.