Patient Financial Counselor
Charlotte, NC
Full Time
Revenue Cycle Management
Experienced
Patient Financial Counselor
Description: The Patient Financial Counselor is responsible for supporting the financial experience of patients throughout the continuum of care within a large, multispecialty physician practice. This position serves as a primary resource for patients regarding insurance benefits, estimated out-of-pocket expenses, payment arrangements, and financial assistance options.
The Patient Financial Counselor plays a critical role in the organization's revenue cycle by proactively identifying and addressing financial barriers to care, promoting financial transparency, improving patient collections, and reducing preventable patient accounts receivable. This role collaborates closely with scheduling, registration, clinical operations, prior authorization, billing, and revenue cycle teams to facilitate financial clearance and ensure a seamless patient experience.
The ideal candidate demonstrates strong financial acumen, exceptional communication skills, compassion, and the ability to navigate complex insurance and billing matters while balancing patient advocacy with the financial objectives of the organization.
Responsibilities:
Patient Financial Counseling and Education
Financial Clearance and Pre-Service Collections
Revenue Cycle Operations and Collaboration
Performance Management and Accountability
Compliance and Patient Confidentiality
Requirements:
Education and Certifications
The Patient Financial Counselor plays a critical role in the organization's revenue cycle by proactively identifying and addressing financial barriers to care, promoting financial transparency, improving patient collections, and reducing preventable patient accounts receivable. This role collaborates closely with scheduling, registration, clinical operations, prior authorization, billing, and revenue cycle teams to facilitate financial clearance and ensure a seamless patient experience.
The ideal candidate demonstrates strong financial acumen, exceptional communication skills, compassion, and the ability to navigate complex insurance and billing matters while balancing patient advocacy with the financial objectives of the organization.
Responsibilities:
Patient Financial Counseling and Education
- Educate patients regarding insurance coverage, deductibles, copayments, coinsurance, out-of-pocket maximums, and potential financial responsibility.
- Provide clear, accurate, and compassionate explanations of patient estimates.
- Proactively engage patients prior to scheduled services to discuss anticipated financial obligations, available payment options, and collection of estimated liabilities.
- Assist patients in understanding insurance-related financial responsibilities, including noncovered services.
- Address patient financial concerns, questions, and disputes professionally, escalating complex issues when appropriate.
- Promote financial transparency while maintaining a positive, patient-centered experience.
Financial Clearance and Pre-Service Collections
- Review scheduled appointments, procedures, and services to identify patients requiring financial counseling or financial clearance.
- Collaborate with scheduling, clinic staff registration, and authorization teams to identify and resolve financial barriers prior to the date of service.
- Verify available insurance and financial information to support accurate determination of patient responsibility.
- Prepare, review, and communicate patient cost estimates for diagnostic testing, procedures, and other specialty services.
- Proactively contact patients with anticipated out-of-pocket expenses to review payment expectations and available financial arrangements.
- Facilitate collection of applicable copayments, deductibles, coinsurance, and other patient-responsible amounts prior to or at the time of service, consistent with organizational policies and applicable regulations.
- Identify potential financial clearance issues and coordinate timely resolution with appropriate departments.
- Document financial counseling activities, patient communications, payment commitments, and unresolved issues within designated systems.
Revenue Cycle Operations and Collaboration
- Work collaboratively with clinical departments, practice leadership, scheduling, registration, coding, billing, and other revenue cycle functions to support efficient patient financial processes.
- Support standardized financial counseling and collection workflows across multiple specialties and practice locations.
- Identify recurring patient billing concerns, insurance issues, and operational barriers that negatively impact financial clearance or collections.
- Communicate opportunities for workflow improvements and participate in initiatives to enhance revenue cycle performance.
- Assist with patient account research, financial inquiries, and escalated billing concerns requiring coordination across departments.
- Maintain familiarity with specialty-specific services, insurance requirements, and financial workflows.
- Support implementation of organizational policies related to patient financial responsibility, payment arrangements, and financial assistance.
- Participate in departmental meetings, training, process improvement activities, and other assigned revenue cycle initiatives.
Performance Management and Accountability
- Meet established productivity, quality, and service expectations related to financial counseling, financial clearance, and patient collections.
- Support achievement of departmental performance indicators, including:
- Pre-service financial clearance completion rates.
- Patient estimate accuracy and timely communication.
- Pre-service and point-of-service collection performance.
- Patient payment plan enrollment and adherence.
- Reduction in aged patient accounts receivable.
- Timely resolution of patient financial inquiries.
- Documentation accuracy and compliance with established workflows.
- Maintain accurate records of patient outreach, financial counseling outcomes, and collection activities.
- Prioritize assigned work queues and patient accounts to ensure timely follow-up and resolution.
- Demonstrate accountability for assigned responsibilities while maintaining a high standard of patient service.
Compliance and Patient Confidentiality
- Ensure all financial counseling and collection activities comply with HIPAA, applicable federal and state regulations, payer requirements, and organizational policies.
- Maintain working knowledge of applicable CMS requirements, patient financial protections, and No Surprises Act provisions.
- Communicate patient financial obligations accurately and transparently, including applicable Good Faith Estimate requirements.
- Maintain confidentiality of protected health information and sensitive patient financial information.
- Follow established policies regarding financial assistance, payment arrangements, collection practices, and account adjustments.
- Exercise sound judgment and professionalism when discussing sensitive financial matters with patients and families.
- Perform additional duties as assigned to support the overall objectives of the Revenue Cycle department.
Requirements:
- Strong understanding of healthcare revenue cycle operations, including patient access, insurance verification, patient financial responsibility, billing, and collections.
- Working knowledge of commercial insurance, Medicare, Medicaid, managed care plans, and patient cost-sharing requirements.
- Ability to interpret insurance benefits, explain complex financial information, and communicate anticipated patient expenses accurately.
- Demonstrated ability to conduct sensitive financial conversations with professionalism, empathy, and discretion.
- Strong customer service, interpersonal, problem-solving, and conflict-resolution skills.
- Excellent verbal and written communication skills with the ability to interact effectively with patients, families, providers, and internal departments.
- Ability to manage multiple priorities and maintain productivity in a fast-paced, high-volume, multispecialty practice environment.
- Strong organizational skills, attention to detail, and commitment to accurate documentation.
- Proficiency with electronic health records, practice management systems, patient accounting platforms, and Microsoft Office applications.
- Ability to independently research patient accounts, identify discrepancies, and coordinate appropriate resolutions.
- Understanding of patient payment plans, financial assistance programs, and healthcare collection practices.
- Ability to work independently while collaborating effectively with multidisciplinary teams.
- Commitment to patient-centered service, financial transparency, and continuous process improvement.
- Experience with athenahealth or comparable electronic health record and practice management systems preferred.
Education and Certifications
- High school diploma or equivalent required.
- Associate degree in healthcare administration, business administration, finance, or a related field preferred.
- Bachelor's degree in healthcare administration, business administration, finance, or a related field preferred.
- Certified Revenue Cycle Representative (CRCR) through the Healthcare Financial Management Association (HFMA) preferred.
- Additional certifications in healthcare revenue cycle management, patient access, or medical billing preferred.
- Minimum of two (2) years of experience in healthcare revenue cycle operations, patient financial services, medical billing, patient access, or a related healthcare financial role required.
- Experience in patient financial counseling, insurance benefit interpretation, payment collections, or financial clearance strongly preferred.
- Experience working in a large, multispecialty physician practice, ambulatory care organization, or integrated healthcare delivery system preferred.
- Demonstrated experience discussing patient financial obligations, establishing payment arrangements, and resolving complex billing inquiries.
- Familiarity with Medicare, Medicaid, commercial insurance, and specialty-specific billing requirements preferred.
- Experience utilizing electronic health records, practice management systems, and patient accounting work queues preferred.
- Experience with athenahealth preferred.
- Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
- Must be able to lift and support weight of 35 pounds
- Ability to concentrate on details.
- Use of computer for long periods of time.
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