Outpatient Financial Counselor

Position Summary Under the general direction of PFC Manager, the Outpatient Financial Counselor (OPFC) has a dual role to help vulnerable BMC patients to access healthcare coverage and to preserve and protect BMC revenue by securing payors to reduce uncompensated care. The OPFC serves as an advocate and navigator, assisting low-income, uninsured and underinsured patients apply for financial assistance programs and secure healthcare coverage. As a Certified Application Counselor, the OPFC will assist patients referred for financial counseling, in person or by phone, from PFC office locations on the hospital campus. Patients presenting for services, by appointment or walk-in, will be screened for eligibility and offered enrollment assistance to secure insurance coverage through MassHealth, Out of State Medicaid, HSN, or BMC’s Charity Care Program. The OPFC is responsible for initiating new applications and assisting with program renewals; for educating patients about health insurance options and eligibility requirements; and for updating patient demographic information, opening financial trackers, and documenting all efforts made to assist patients in applying for insurance coverage. The OPFC will embody BMC’s mission, vision, and values and follow policy and procedure regarding BMC’s billing and collection practices and the Certified Application Counselor Designation Agreement between BMC and MassHealth. Essential Responsibilities / Duties Demonstrates respectful personal conduct and utilizes AIDET when engaging patients and visitors. Completes MassHealth’s curriculum for Certified Application Counselor and renews certification annually. Provides information about the full range of medical and dental insurance programs available through the Health Insurance Exchange (HIX). Interviews patients, in a language and manner best understood, to determine eligibility and communicate enrollment options and plan benefits for which patients qualify. Answers questions about Qualified Health Plans (QHP) and Qualified Dental Plans (QDP). Explains subsidized Qualified Health Plans available through premium tax credits or informs patients of expected out-of-pocket expenses, co‑pays, and deductibles when applicable. Utilizes protected software programs to determine patient eligibility for MassHealth, Health Safety Net, ConnectorCare, and other insurance carriers and assists with the enrollment process. Provides in-person assistance at PFC office locations in Yawkey and Shapiro buildings, to offer outreach and education or initiate new applications or plan renewals for health insurance coverage. Informs patients of important deadlines, effective dates for coverage, and required documentation to determine eligibility. Scans MassHealth applications and supporting verification documents into HIX and patients’ Epic record. Documents in Epic the status of all applications initiated by adding a financial tracker and recording actions taken and follow‑up efforts required to complete and submit for processing. Assists patients with enrolling in an ACO or changing their selection of ACO to ensure continued access to covered services. Provides voter registration information and registration assistance as needed; completes the appropriate patient declination form for applicants as requested. Validates and updates active insurance coverage in the hospital registration and billing system on accounts with covered dates of service. Assists patients with billing questions or concerns. For patients deemed ineligible for financial assistance programs, provides information regarding self‑pay discount and payment plan options. Collects and posts payments for balances related to self‑pay, Ad‑Hoc, and Flat Fee contracts in accordance with BMC policy and procedure for collection practices. Interacts with numerous departments to resolve insurance and billing questions, e.g., Customer Service, Pharmacy, Social Service, Case Management, Patient Accounts, Clinic Staff, Unit Nursing staff, professional billing etc. Understands and adheres to rules established by the BMC Credit and Collection Policy. Assists patients with confidential applications for protected services, adding account notes to notify others of the patient’s protected status. Assists patients with medical hardship and confidential applications, obtaining and submitting verification documents and applicable medical bills required to apply and make a determination of eligibility. Responds to telephone calls in a courteous manner. Responds promptly to all inquiries from staff, patients, and general public. As needed, refers callers to other departments or resources deemed appropriate for resolution. Presents and interacts respectfully and professionally with BMC patients, visitors, and other team members; works cooperatively and respectfully with other departments and disciplines across the organization. Maintains daily written reports of work activity to document patient enrollments and outcomes; patient complaints and resolutions; patient declinations, etc. Demonstrates superior customer service standards. Participates in regular staff meetings and scheduled trainings to maintain required core competencies. Serves as a resource and subject matter expert regarding financial assistance programs. Provides education and advisement on health insurance options and enrollment requirements for other hospital departments, community health centers, community leaders and other personnel as needed. Under the direction of PFC Manager, assists with the orientation including shadowing, of new staff as assigned. Validates and/or updates demographic and income information in HIX portal for "known" patients with prior history of program eligibility. Validates patients’ active insurance coverage and updates current plans in Epic. Collects and posts payments on accounts with outstanding balances. Maintains and closes Epic Cash Drawer and documents transactions in patients’ financial trackers. Schedules tasks for Financial Counseling Enrollment Coordinators (FCECs) to conduct patient follow‑up on pending applications to ensure that required documents are obtained and applications are completed and submitted timely to secure retroactive coverage. Protects patient and family confidentiality. Performs other duties and tasks as assigned. Job Requirements Education: High School diploma with 3‑5 years of strong customer service experience in healthcare or human services setting required. Bachelor’s degree strongly preferred. Certificates, Licenses, Registrations Required: Must complete MassHealth’s curriculum for Certified Application Counselor (CAC) and maintain certification renewal annually. Individual must complete training and obtain CAC certification within 45 days of hire date. Experience: 2‑3 years of strong customer service experience, preferably in a healthcare or human services setting. Bilingual persons and persons with hospital and/or healthcare experience strongly preferred. Knowledge and Skills: Demonstrates professionalism, maturity, and confidence needed to work effectively in a diverse, multi‑cultural, and decentralized environment. Displays strong, consistent communication skills (oral and written), interpersonal skill, and record‑keeping skills. Demonstrates knowledge and understanding of eligibility criteria and application process for programs offered through MassHealth, Health Safety Net, ConnectorCare, and BMC’s Charity Care Program. Displays strong organizational skills with ability to manage multiple tasks simultaneously; prioritize work assignments appropriately; and complete follow‑up tasks timely. Demonstrates strong work ethic and ability to meet performance goals for productivity and outcomes with minimal direct supervision. Demonstrates critical thinking and sound judgment in addressing and resolving barriers, issues, or concerns identified. Requires strong technical computer skills and proficiency in utilizing Epic and external database systems to research cases and successfully assist patients in securing active coverage. Displays exceptional customer skills and the ability to engage patients, family members, and team members respectfully, with empathy and cultural sensitivity. Additional Requirements: Must be vaccinated against COVID‑19 and flu, and receive a booster dose of the COVID‑19 vaccine. Compensation Range $25.25 – $30.78 per hour. This range offers an estimate based on the minimum job qualifications. Compensation is determined by a comprehensive assessment of education, experience, and relevant certifications. BMC also offers benefits including medical, dental, vision, pharmacy, contract increases, flexible spending accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and additional employee support resources. Equal Opportunity / EEO Statement Boston Medical Center is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression, or any other non‑job‑related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e‑mail to View email address on click.appcast.io or call View phone number on click.appcast.io. BMC participates in the Electronic Employment Verification Program. As an E‑Verify employer, prospective employees of BMC must complete a background check before beginning employment. #J-18808-Ljbffr Boston Medical Center