Financial Counselor

Children’s Hospital of Philadelphia•Philadelphia, PA

1d•$27 - $34•Hybrid

About The Position

This role requires strong professional phone presence, independent judgment, and advanced knowledge of insurance and registration processes. The Financial Counselor is responsible for comprehensive insurance verification, financial assistance assessments, and detailed benefit collection and authorization processes for patients seeking care at CHOP. In this position, the Financial Counselor will manage insurance verification, conduct in-depth benefit reviews, and identify covered and non-covered services. The role includes clearly explaining benefit structures and maintaining proactive communication with families, providers, and payors regarding referrals, authorizations, FHCP eligibility, and a wide range of insurance eligibility and service authorization matters. The Financial Counselor will also provide cross-coverage support across other areas as needed, ensuring continuity of service and operational excellence. Expected Evolution of the Role This role is designed to grow in both scope and impact, offering meaningful opportunities for professional development and specialization. Over time, the position will evolve to include: Increased payer-specific specialization, enabling deeper expertise and stronger partnerships that drive optimized outcomes. Greater involvement in denial prevention strategies, positioning the role as a critical contributor to revenue protection and operational efficiency. Expanded use of automation and analytics, leveraging data-driven insights and modern tools to enhance accuracy, speed, and decision-making. Cross-training across service lines and financial workflows, fostering a well-rounded skill set, increased collaboration, and long-term career growth. Flexible Work Location & Team Connection The primary work location for this role is home/remote. The position balances flexible work arrangements with a collaborative team environment and requires quarterly onsite meetings at the Main CHOP Hospital.

Requirements

High School Diploma / GED Required
Medical Insurance background
Strong customer service experience
Ability to work with stressful situations
Ability to function efficiently and professionally with minimum of supervision.
Ability to quickly learn new procedures.
Strong computer skills.
Ability to juggle multiple insurance issues.
Strong customer service skills
Ability to display compassion and empathy
Mandatory required training within first 30 days:
ACD Software Training
Website Insurance Training (Navinet, WebMD, Passport)
EPIC training & testing (Prelude/Cadence).
Registration Essentials
Cardiac Center databases

Nice To Haves

Associate's Degree Preferred
Background in medical terminology Preferred
EPIC registration Preferred
Resource scheduling experience (i.e. ancillary testing) Preferred

Responsibilities

Responsible benefit detail and authorizing the services
Demonstrates an understanding and provides information of benefit structures to patients, physicians, and hospital practices as well as provides information on the following areas:
Hospital prompt pay and payment plan policies
Authorization issues
Contract participation
Process for pre-cert/pre-auth of non covered services
Provider ID numbers & CPT codes (if applicable)
Verify coverage & benefit information via electronic eligibility or by contacting payor and documenting relevant information in Epic
Follows up with insurance companies and families of patients identified as ineligible or non-covered
Contacts family and/or responsible party, as necessary, to inform them of any financial assistance or insurance applications statuses, insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party. Contact clinical office with all information that requires follow-up.
Support financial assistance assessment and/or insurance applications to obtain coverage as needed.
Responsible for review, vetting, and dissemination of all Philadelphia Health Center Referrals, and Community Partner referrals received by Department
Educates families and clinical team regarding insurance coverage plans.
Stay abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy.
Leverages benefit collection information and Epic tools to clear services and create estimates for services
Respond to emails, answer calls, provide explanation of covered and non-covered services
Contacts appropriate clinical staff in timely manner with all information that requires follow-up.
Review diagnosis/procedure codes to ensure they are documented correctly and accurately reflect the clinical information and services to be performed.
Discuss and send pertinent medical history to complete authorization process.
Discuss, interpret and send pertinent medical history to complete authorization process (inclusive of pre-determinations).
Work on complex medical cases that are in pending status until cases are complete and works with clinical teams for additional clinical information and/or a letter of medical necessity.
Notify physician office/hospital of coverage issues, denials due to procedures not medically necessary, or if insurance carrier requires additional clinical information and/or peer to peer requests.
Prioritize daily requests based on date of service, insurance carrier requirements, unexpected date changes or urgent requests, while processing request within department standards.
Coordinates appeals or retrospective review as needed following up on payor denials
Ability to convert common diagnosis descriptions to numeric ICD 9 or CPT code.
Partner with specialist to outline correct CPT Codes, NPI, and authorization details for specific services for Single Case Agreement