Senior Financial Counselor (PFS)

BMC Software•Boston, MA

3d•$29 - $42

About The Position

The Senior Financial Counselor supports patients who need financial counseling to access healthcare coverage, while contributing to accurate registration and financial eligibility processes. The position works across centralized and decentralized patient care settings and supports clinical operations as needed. Under the general supervision of the Supervisor of Financial Counseling, the counselor assists uninsured and underinsured patients with coverage options including MassHealth, Medicaid, Health Safety Net, Connector Care, Medicare-related programs, and BMC’s Charity Care Program. The role provides advocacy and continuity of support throughout applications, eligibility determinations, and appeals. As a certified SHINE counselor, the Senior Financial Counselor provides free health insurance information and counseling to Medicare-eligible patients and caregivers in inpatient and outpatient settings. The position manages a high volume of cases from initial engagement through resolution and supports financial counseling practices that meet BMC’s mission and applicable billing, collection, regulatory, and hospital requirements.

Requirements

High school diploma or GED.
At least 3 years of experience in financial counseling and hospital registration, or an equivalent combination of education and experience.
MassHealth Certified Application Counselor (CAC) certification.
Serving the Health Insurance Needs of Everyone (SHINE) certification.
Knowledge of healthcare coverage programs, including MassHealth, Health Safety Net, ConnectorCare, Charity Care, and Medicare-related coverage, and ability to apply program rules to determine eligibility and guide enrollment.
Skill in financial counseling case management, including tracking high volumes of cases using work queues, worklists, and financial systems.
Ability to meet established productivity and outcome goals, including SHINE and financial counseling quality and performance metrics.
Skill in obtaining, verifying, and maintaining accurate patient demographic, financial, and visit-specific information.
Analytical and problem-solving ability to resolve barriers involving enrollment, eligibility, documentation, or access to coverage programs.
Ability to manage competing priorities while maintaining accuracy, productivity, and compliance with departmental, regulatory, and other requirements.
Ability to work independently under general supervision and collaboratively with cross-functional teams.
Strong written and verbal communication skills, including explaining complex insurance information clearly and maintaining accurate documentation.

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Assist uninsured and underinsured patients in obtaining coverage through MassHealth, Medicaid, Health Safety Net, Connector Care, Medicare programs, and BMC’s Charity Care Program.
Facilitate applications, appeals, and eligibility notifications, and guide patients on cost-saving options.
Educate patients about Medicare Part D, Medigap, Senior Care Options (SCO), and Medicare Savings Programs; refer patients to external resources such as Boston ElderINFO.
Serve as a resource to patients and staff on insurance eligibility, SHINE program options, and payor enrollment and disenrollment.
Maintain Certified Application Counselor and SHINE certifications, including required curriculum, annual recertifications, and monthly activity requirements.
Participate in departmental trainings and meetings, including SHINE leadership meetings, to support collaboration and continuous improvement.
Conduct full registration and verify patient insurance using established methods.
Ensure patient demographic, insurance, and admission data are accurate in BMC’s information system.
Contact patients by phone, email, mail, or through interpreter services to obtain applications, consent forms, and verification documents.
Document information accurately in patient accounts, update coverage and billing indicators, and track pending applications through final disposition.
Use work queues, protected software, and reporting tools to identify self-pay accounts and monitor pending applications.
Close financial trackers and ensure applications are completed in compliance with regulatory and hospital standards.
Identify opportunities for retroactive coverage and respond to billing inquiries by advising patients about payment plans, discounts, and charity care options.