Financial Counselor

About the role

The Financial Counselor is responsible for the timely and accurate follow-up and resolution of unpaid patient balances. This position manages a high volume of patient interactions related to self-pay accounts, analyzes patient responsibility, obtains and verifies insurance information, establishes payment arrangements, and processes patient payments. The Financial Counselor serves as a billing representative, resolving patient financial concerns that may impact a patient’s ability to receive services.

Responsibilities

• Respond to a high volume of incoming patient calls related to self-pay statements, billing inquiries, and payment concerns.
• Initiate outbound collection calls to patients on an ongoing basis in a professional and customer-focused manner.
• Review and monitor assigned accounts and collection reports to ensure timely follow-up and resolution.
• Analyze self-pay balances to determine patient financial responsibility, including deductibles, coinsurance, and contractual discounts.
• Establish and monitor payment arrangements and provide timely follow-up on agreed payment plans.
• Process patient payments accurately and in accordance with company procedures.
• Research accounts deemed potentially non-collectible and prepare them for referral to collection agencies as appropriate.
• Ensure all available payment resources have been researched and exhausted prior to escalation.
• Identify billing issues requiring further review (e.g., claim corrections, appeals) and communicate findings to appropriate billing staff through documented patient cases.
• Handle billing loop calls and respond to inquiries from patients, physician offices, and insurance companies.
• Resolve patient billing problems while maintaining excellent customer service and preserving patient relationships.
• Address patient concerns in a calm, courteous, and professional manner, including interactions with dissatisfied patients; escalate concerns to the Quality Department as needed.
• Meet established productivity metrics and key performance indicators (KPIs).
• Maintain compliance with HIPAA and all company plans, policies, and procedures set forth by Orthopaedic Solutions Management.
• Perform reports, projects, and other duties as assigned.

Requirements

• High School Diploma or GED required.
• Minimum of 5 years of prior medical billing experience or equivalent required.
• Working knowledge of CPT and ICD-10 coding required.
• Demonstrated understanding of Explanation of Benefits (EOBs) and reimbursement practices, including deductibles, coinsurance, and contractual adjustments.

Skills

• Strong knowledge of insurance guidelines and payer requirements.
• Excellent customer service skills with the ability to handle sensitive financial conversations.
• Strong attention to detail with a high level of accuracy.
• Effective verbal and written communication skills.
• Ability to work independently with minimal supervision while meeting goals, deadlines, and performance metrics.
• Ability to manage multiple tasks in a deadline-driven environment.
• Professional, well-presented, and tactful demeanor.
• Ability to work collaboratively as part of a team and meet the expectations of internal and external customers.