Remote Patient Financial Counselor

About the role

The National Patient Financial Counselor assists patients in navigating health insurance options through the Health Insurance Marketplace and Medicaid programs. Responsibilities include determining eligibility, supporting patients through the application process, guiding them in selecting a Marketplace Plan or Medicaid Managed Care Organization (MCO) without directing them toward a specific plan, and assisting with renewals/revalidations to help maintain continuous coverage. The role also handles patient financial responsibilities such as reconciling balance journals, processing verified patient reimbursement requests, and responding to patient and facility inquiries regarding balances. Exceptional patience, empathy, and professionalism are required when helping patients navigate sensitive financial and healthcare matters.

Responsibilities

• Assist patients with understanding and navigating the Health Insurance Marketplace and Medicaid application processes, including eligibility, enrollment, and renewals.
• Provide education on Health Insurance Marketplace and Medicaid Managed Care Organization (MCO) options and support patients in making informed decisions.
• Conduct patient interviews to collect necessary information for insurance and payment assistance programs.
• Offer ongoing support post-enrollment to help maintain patient coverage.
• Document patient interactions and maintain accurate records for reporting and compliance.
• Communicate effectively and compassionately with patients, insurance companies, and internal teams.
• Address patient balance inquiries, process refunds, reconcile accounts, and collaborate with clinics on account resolution.
• Work closely with internal teams to ensure coordinated patient support and accurate financial management.
• Perform special projects and other duties as needed, including using Excel/Google spreadsheets to assist with special projects and communicate results.
• Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Essential Qualifications

• Education/Licensure/Certification: High school graduate or equivalent.
• Required Knowledge: Minimum of 1 year of experience in customer service, with demonstrated skills in reading and interpreting balance journals, managing insurance accounts receivable, and assisting patients with health coverage enrollment, including applications for the Health Insurance Marketplace or Medicaid.
• Experience Required: 2+ years experience in customer service, with demonstrated skills in reading and interpreting balance journals, managing insurance accounts receivable, and assisting patients with health coverage enrollment, including applications for the Health Insurance Marketplace or Medicaid.
• Knowledge/Skill/Ability:
  • Knowledge of insurance policies, CPT and ICD10, and payer requirements.
  • Excellent communication and interpersonal skills, with the ability to interact effectively with patients, payers, and clinical staff.
  • Detail-oriented with strong organizational and problem-solving skills.
  • Strong understanding of and ability to use software and systems, including but not limited to electronic medical record systems, Microsoft Office, and Google Docs/Sheets; daily use of laptop/computer for email, note taking, and other tasks required.
• Preferred: Bilingual in English and Spanish.

Job or State Requirements

High school diploma or equivalent.