Financial Counselor

Nira Medical

About The Position

The Financial Counselor is a patient-facing member of the central Revenue Cycle Management (RCM) team. The role educates infusion patients about their insurance coverage and benefits, conducts welcome calls, provides cost estimates, assesses financial need, helps patients access co-pay assistance and grant programs, and arranges payment plans before treatment begins. The Financial Counselor works closely with Infusion Coordinators at clinic sites and the Benefits Verification/Prior Authorization (BVPA) team so patients are financially cleared, informed, and ready for treatment and infusion orders are processed accurately and on time. The position may be based in person at a clinic site or remotely. It involves communicating directly with patients by phone, virtually, and/or in person.

Requirements

High school diploma or equivalent.
Excellent verbal and written communication skills, strong interpersonal and patient contact skills, excellent telephone manners, and the ability to explain insurance terminology clearly.
Working knowledge of insurance coverage, benefits, and terminology, including co-pays, deductibles, and out-of-pocket maximums.
Experience preparing patient cost estimates and arranging payment plans.
Knowledge of medical terminology and clinical documentation review.
Compassion and professionalism when discussing sensitive financial topics with patients.
Strong organizational skills and attention to detail.
Ability to multitask and work well in a fast-paced setting.
Critical-thinking skills and decisive judgment.

Nice To Haves

Associate degree in finance or business, or equivalent revenue cycle experience.
Minimum of two years of patient benefits experience, with experience in financial counseling, pre-service coordination, or insurance billing for medical services.
General knowledge of ICD-10 and CPT codes.
Infusion or specialty medication experience.
Experience with financial assistance, co-pay assistance, or grant applications.
Experience with, or ability to quickly learn, EHR and infusion management systems such as Athena and WeInfuse.

Responsibilities

Serve as the primary financial contact for patients regarding the insurance and financial aspects of infusion treatment.
Conduct patient welcome calls, explain the financial clearance process, set expectations, and answer initial questions about coverage and costs.
Obtain and confirm insurance coverage information and demographics before treatment begins.
Explain verified insurance benefits, including co-pays, deductibles, and out-of-pocket expenses, using information from the BVPA team.
Assess patients’ ability to meet financial obligations and identify those who may need assistance.
Prepare and review treatment cost estimates with patients based on verified benefits.
Discuss payment options, arrange payment plans, and ensure patient responsibility amounts are accurately recorded before treatment.
Respond clearly and compassionately to questions about coverage, authorization status, and costs.
Verify insurance eligibility and update patient demographics and coverage in the system according to established procedures.
Track patients’ progress through financial clearance.
Screen patients for financial assistance and refer or enroll eligible patients in manufacturer co-pay assistance programs and foundation grants.
Complete assistance program enrollment, confirm activation, and monitor benefits and renewals.
Complete grant and assistance applications, gather required documentation with local teams, and follow up on decisions and renewals.
Stay current on financial assistance programs and build professional relationships with manufacturers and foundations to identify resources for patients.
Track enrollment and grant status and communicate confirmation to Infusion Coordinators so patients can be scheduled.
Communicate with patients and providers about the insurance and financial status of infusion orders.
Collaborate with Infusion Coordinators, the BVPA team, and central RCM colleagues to resolve financial barriers and keep orders moving.
Document patient, payer, and provider communications and financial activity in designated systems, such as Athena and WeInfuse, and maintain accurate records.
Follow HIPAA and applicable confidentiality, state, and federal requirements concerning patient information.