Patient Financial Counselor

Chapters Health System•Temple Terrace, FL

About The Position

The Patient Financial Counselor is responsible for providing patients with a positive financial experience by helping patients navigate and understand insurance benefits and potential financial liability. Patient Financial Counselors are the patient’s point of contact for financial assistance questions. The Patient Financial Counselor collects patient payments, sets up payment plans as appropriate and according to guidelines, creates estimates, advises patients over the phone and in person regarding their insurance benefits and coverage. This role gathers essential information used to determine eligibility for government programs, financial assistance programs (charity care), and other options for managing high financial liabilities. Independent judgment and decision making is required to address the full range of tasks and responsibilities. The position requires the ability to plan, schedule and organize numerous tasks that directly impact reimbursement. This position represents Chapters Health System and the Revenue Cycle team.

Requirements

At least 3 years Patient Financial Counseling or Social Worker experience preferably at a hospital, hospice or other acute care setting.
Associate’s degree or comparable experience
Experience establishing health insurance benefits, conditions, and requirements by making phone inquiries, and by using online eligibility systems.
Ability to communicate compassionately and professionally with patients and families.
Knowledge of medical insurance and government payers and reimbursement
Excellent customer service skills and experience.
Proficiency in Microsoft Office applications, especially Excel.
Familiarity with healthcare regulations.

Responsibilities

Serve as primary financial resource for patients/caregivers prior to admission and/or throughout the episodes-of-care, in collaboration with Admissions/Referral Center.
Explain insurance benefits, coverage limitations, patient liability, cost-sharing, and non-covered services in clear, compassionate terms.
Provide estimates of patient financial responsibility, including copays, coinsurance, deductibles, and private-pay rates.
Assist patients with financial assistance applications, Medicaid spend-down, or alternative payment options when applicable.
Verify/Reverify insurance eligibility, benefit levels, and post-acute coverage requirements.
Understand and track prior authorizations, re-certifications, and continued stay reviews with payers.
Identify coverage carve-outs, managed care restrictions, payer-specific documentation needs.
Collaborate with Hospice Admissions/Referral Center to include Social Workers and other internal admissions teams to facilitate smooth transitions to post-acute care.
Ensure financial clearance prior to admission whenever possible, balancing financial integrity with patient access.
Identify coverage risks in collaboration with Insurance Verification Team and escalating issues appropriately.
Document insurance verifications, counseling discussions, etc., accurately in the patient account.
Ensure compliance with Medicare, Medicaid, and commercial payer regulations related to post-acute services.
Identify potential denial risks related to coverage, length of stay, or medical necessity and communicate proactively.
Support audits, payer reviews, and appeals by providing accurate financial documentation.
Meet established productivity, accuracy, and timeliness benchmarks.
Contribute to denial prevention, reduced avoidable write-offs, and improved point-of-entry financial clearance and/or collections.
Participate in ongoing training related to payer rules, hospice reimbursement, and regulatory changes.