Financial Counselor
About The Position
The Financial Counselor serves as the primary patient advocate for financial navigation and counseling within an oncology practice. The role reviews insurance coverage, establishes financial responsibility estimates, and coordinates prior authorizations and benefit verification to support access to cancer treatment. The counselor helps patients understand insurance benefits, out-of-pocket costs, and available financial assistance, and works with clinical teams, insurers, and external assistance organizations to address financial barriers and collect patient balances compassionately. The position monitors insurance pre-certification and authorization processes, reviews upcoming appointments and treatment plans, verifies coverage, and prepares and explains service estimates. It also supports patients with financial assistance applications, grant programs, payment arrangements, and outstanding balances. The counselor is expected to comply with applicable laws, regulations, HIPAA requirements, and organizational policies, while communicating professionally and compassionately with patients and families.
Requirements
- High school diploma or equivalent.
- At least two years of experience in the healthcare field.
- Knowledge of verifying medical insurance pre-certification and/or prior authorization.
- Prior cash-handling and monetary collection experience.
- Ability to calculate and collect patient responsibility, insurance copayments, and coinsurance.
- Insurance knowledge, including understanding of medical terminology and ICD-9, ICD-10, and CPT codes.
- Strong verbal and written communication skills to support diverse patient populations with empathy and cultural sensitivity.
- Familiarity with patient assistance programs, grant-funded resources, and pharmaceutical assistance programs.
- Proficiency with EMR systems, practice management software, and insurance verification tools.
- Advanced proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.
- Strong interpersonal and communication skills, including the ability to explain financial information in understandable terms.
- Ability to collaborate with clinical teams, insurance companies, and external organizations.
Nice To Haves
- Associate’s degree or higher in Healthcare Administration, Business, or a related field.
- Experience in healthcare financial counseling, patient access, or medical billing.
- Experience with patient assistance programs and financial aid resources.
Responsibilities
- Coordinate pre-certification and prior authorization processes with insurance companies, including peer-to-peer reviews and appeals, seeking provider or pharmacy support when applicable.
- Review patient and physician schedules for upcoming visits or treatments and establish patient financial responsibility.
- Review treatment plans to verify active insurance coverage and patient responsibility, and promptly communicate unplanned exceptions to providers.
- Identify new treatment orders, generate service estimates, and explain insurance benefits and financial responsibility to patients.
- Maintain current insurance benefit information in EMR systems and review services for diagnosis and coverage appropriateness.
- Communicate throughout the workday with providers, nursing staff, PSS staff, the UM team, and coworkers about financial responsibility and related matters.
- Explain required forms and paperwork, including waivers, treatment estimates, payment plans, and assistance applications.
- Help patients complete paperwork for financial aid and grant-funded programs.
- Coordinate with patient assistance programs and grant services to support applications, placement, and financial aid counseling.
- Collect information needed to assess eligibility under assistance program income guidelines, when applicable.
- Review aging patient balances and establish appropriate arrangements with patients to address outstanding balances.
- Work with external organizations to complete required forms and items accurately and promptly, including urgent requests.
- Monitor and collect patients’ financial responsibilities compassionately and professionally.
- Comply with federal and state laws and regulations relating to patient care, rights, safety, billing, and collections.
- Protect the confidentiality of patient and employee information in accordance with HIPAA.
- Follow company and departmental policies and procedures.
- Advocate for patients navigating financial complexities and communicate sensitively with patients and families.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
