Job Summary: The Financial Counselor is a patient-facing member of the central Revenue Cycle Management (RCM) team, responsible for educating infusion patients on their insurance coverage and benefits, conducting patient welcome calls, providing cost estimates, assessing financial need, enrolling patients in co-pay assistance and grant programs, and arranging patient payment plans before treatment begins. The role partners closely with the Infusion Coordinators, who serve as the local point of contact at each clinic site, and with the Benefits Verification/Prior Authorization (BVPA) team to ensure patients are financially cleared, informed, and ready for treatment so infusion orders are processed accurately and on time.
Key Responsibilities:
Patient Financial Counseling & Education (Patient-Facing)
Serve as the primary financial contact for patients, communicating with them directly regarding the insurance and financial aspects of their infusion treatment.
Conduct patient welcome calls to introduce the financial counseling role, set expectations for the financial clearance process, and answer initial questions about coverage and costs.
Obtain and confirm insurance coverage information and demographics prior to the start of treatment.
Educate patients on their insurance coverage and verified benefits, including co-pays, deductibles, and out-of-pocket expenses, using benefit information provided by the BVPA team.
Assess patients' ability to meet their financial obligations and identify those who may need financial assistance.
Prepare and review cost estimates with patients, outlining their expected financial responsibility for infusion treatment based on verified benefits.
Discuss payment options and set up payment arrangements with patients and ensure patient responsibility amounts are accurately recorded in the system prior to treatment.
Answer patient questions about coverage, authorization status, and costs in a clear, compassionate manner.
Insurance Eligibility & Authorization Requirements
Verify insurance eligibility and verify and update demographics and insurance coverage in the system according to established procedures.
Track patients' progress through the financial clearance process.
Patient Financial Assistance
Screen patients for financial assistance eligibility and refer or enroll those who express financial necessity in manufacturer copay assistance programs and/or foundation grants.
Enroll eligible patients in manufacturer co-pay assistance programs, including completing enrollment, confirming activation, and monitoring program benefits and renewals.
Complete grant and assistance applications on behalf of patients, gather required documentation in coordination with local teams, and follow up on application decisions and renewals.
Stay current on available financial assistance programs and build professional relationships with manufacturer programs and foundations to identify additional resources for patients.
Track enrollment and grant status and communicate confirmation of financial assistance enrollment to Infusion Coordinators so patients can be scheduled.
Communication, Collaboration & Documentation
Communicate with patients and providers regarding the insurance and financial status of infusion orders.
Work collaboratively with Infusion Coordinators, the BVPA team, and other central RCM colleagues to resolve financial barriers and keep orders moving.
Document all patient, payer, and provider communications and financial activity in designated systems (e.g., Athena, WeInfuse) and maintain accurate logs and records.
Adhere to HIPAA and all applicable confidentiality, state, and federal requirements regarding patient information.
Qualifications:
High school diploma or equivalent; associate degree in finance or business, or equivalent revenue cycle experience, preferred
Excellent verbal and written communication skills, including superior interpersonal and patient contact skills, excellent telephone manners, and the ability to explain insurance terminology clearly to patients
Minimum of two years of patient benefits experience preferred, with experience in financial counseling, pre-service coordination, or insurance billing for medical services and general knowledge of ICD-10 and CPT codes; infusion or specialty medication experience is a plus
Working knowledge of insurance coverage, benefits, and terminology (co-pays, deductibles, out-of-pocket maximums), and experience preparing patient cost estimates and arranging payment plans
Experience with financial assistance, copay assistance, or grant applications is a plus
Experience with, or ability to quickly learn, EHR and infusion management systems (e.g., Athena, WeInfuse)
Knowledge of medical terminology and clinical documentation review
Compassion and professionalism when discussing sensitive financial topics with patients
Strong organizational skills
Detail-oriented
Ability to multi-task and work well in a fast-paced setting
Critical thinking skills and decisive judgment
Work Environment & Location:
This position may be based in person at a clinic site or remote, and includes direct communication with patients by phone, virtually, and/or in person.