Financial Counselor

Title: Financial Counselor Department: Operations Status: Non-Exempt Position Classification/Category: Clerical Level: N/A Location: Assigned Clinic Hourly Pay Range: Reports To: Billing Manager Direct Reports: N/A Summary of Position The Financial Counselor help patients understand and access financial assistance programs like Medicaid and sliding fee scales, assist with applications, and provide education on healthcare costs to ensure equitable access to care for vulnerable populations. This position ensures accurate verification of benefits, grant eligibility, and authorization from third-party payers for services rendered. The Financial Counselor also assists patients in navigating available financial assistance programs, including Medicaid, and must be Certified as an Application Counselor (CAC) to support patient enrollment into Medicaid and Marketplace plans. The role maintains accurate account information while ensuring compliance with CRCHC policies, procedures, and regulatory requirements. Minimum Qualifications Ability to read, write and comprehend the English language. Communicate effectively, must be able to sit and stand for long periods of time. Ability to effectively maintain confidentiality of records and communicate with all levels of personnel. Education/Experience: High School Diploma or GED. Associate degree preferred; or one to two years’ related experience and/or training; or equivalent combination of education and experience. Community Health Center Background. 1-3 years’ experience in healthcare or business field. Additional skills required: Knowledge of medical terminology. Familiar with basic computer operations. Good verbal and written communication skills in English and the specified language(s). Current State Driver’s License, Knowledge of Medicare, NC Medicaid, Commercial, and Sliding Fee payment methods. Additional skills preferred: Strong customer service skills. Certification(s)/Licensure: Complete the Certified Application Counselor (CAC) certification exam within 6 months of hire. Key Responsibilities Identify and assign the appropriate insurance plan, financial class, and coordination of benefits for each patient, ensuring accuracy in documentation to prevent billing errors and delays in reimbursement. Maintain up-to-date payer plan information in the Athenahealth EHR system. Contact third-party payers to verify patient eligibility, coverage levels, and benefits prior to services being rendered. Secure prior authorizations for procedures, diagnostics, and specialty visits as required. Record all payer communications, reference numbers, and authorization details in patient records promptly and accurately. Serve as a Certified Application Counselor (CAC) by assisting patients and families with Medicaid and Marketplace applications, renewals, and eligibility determinations. Provide patients with step-by-step guidance throughout the enrollment process, explain program requirements, and follow up on pending applications to ensure successful enrollment and coverage activation. Actively work to transition self-pay patients into Medicaid or other eligible coverage programs in order to reduce patient out-of-pocket burden and financial risk to CRCHC. Track patient application status and provide ongoing support until enrollment is completed. Develop individualized financial plans for uninsured and underinsured patients, including setting up payment arrangements, determining eligibility for CRCHC’s sliding fee discount program, and referring patients to additional assistance resources when appropriate. Provide patients with detailed explanations of deductibles, co-payments, co-insurance amounts, and estimated total costs for services. Ensure patients clearly understand their financial responsibility and available payment or assistance options. Collect, process, and post patient payments at the time of service according to established CRCHC policies. Issue receipts, reconcile daily collections, and maintain accurate financial records for all patient transactions. Initiate and manage outreach to patients with self-pay balances, working to establish and document payment arrangements or connect patients to financial assistance resources. Escalate delinquent accounts for follow-up in accordance with CRCHC policies. Collaborate closely with CRCHC staff to screen patients for Medicaid, Medicare, and internal financial assistance eligibility. Provide necessary forms, explain requirements, and assist patients with completion and submission of documentation. Act as a point of contact for patient billing questions by clearly explaining billing statements, account balances, and coverage details. Assist in resolving disputes or discrepancies by coordinating with the billing team and clinical staff. Ensure all patient financial records are accurate, up to date, and compliant within the Athenahealth EHR system. Perform routine audits of account information and maintain a high level of accuracy in data entry. Participate in CRCHC community outreach activities, including traveling to various sites and events to provide financial counseling, assist with Medicaid and Marketplace enrollment, and promote access to CRCHC services. Uphold strict confidentiality of all patient information and adhere to HIPAA regulations, CRCHC policies, and federal and state compliance standards at all times. Maintain knowledge of payer policies, Medicaid and Marketplace updates, and CRCHC financial assistance guidelines to ensure accurate counseling and compliance with regulations. Maintain knowledge of Federally Qualified Health Center (FQHC) policies, procedures, and compliance requirements to ensure all financial counseling, billing, and enrollment activities align with federal and organizational standards. Performs all other duties assigned by management. #J-18808-Ljbffr