Financial Counselor

Title: Financial Counselor

Hours: 40 hours per week; Monday through Friday from 8:00 AM to 4:30 PM

Location: Onsite at Tufts Medical Center - Boston, MA

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Financial Services duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted claims, and performs appeals for non-clinical denials, etc. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is closely supervised and communicates information that requires little explanation or interpretation.

Job Overview

The position coordinates insurance verification and financial counseling for all patients within Tufts Medicine. This includes outpatient, inpatient, and ED patients. The position will assist and educate all uninsured and underinsured patients through the process of obtaining benefits so they can access the care they need and to ensure reimbursement to Tufts Medicine for the services provided. 

Job Description

Minimum Qualifications:

1. High school diploma or equivalent

2. One (1) year of hospital/health care experience in the areas of Patient Access.

3. CAC Certification within 4 weeks of hire

Preferred Qualifications:

1. Associates degree

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned.

1. Ensures that all appropriate demographic and insurance information is captured on each inpatient admission.  Verifies eligibility and benefit levels by the next business day following the date of admission.

2. Responsible for identifying patients who are Medicaid eligible and completing Medicaid applications for patients who fall within the Medicaid assistance guidelines.  This includes interviewing family members, attorneys, outside social service agencies or other professionals as needed in order to obtain the information necessary to complete this process.  Information pertaining to asset and income verification will also be required.

3. Meets with patients in the ED or inpatient care setting.

4. Communicates effectively and timely with patient/family and other colleagues.

5. Works collaboratively with Case Management, Social Work, MDs and other clinical team members.

6. Clearly documents all work completed in EMR.

7. Follows applications from submission through final decision. Updates EMRs accordingly and communicates with patients/families of the final decision and any next steps that need to be completed.

8. Assists patients with enrollment in Managed Care/ACO plans, enrollment via the Health Connector, employer sponsored insurance/COBRA, or Medicare plans.

9. Assists patients in applying for Tufts Medicine Financial Assistance application. Follows application from submission through final determination.

10. Assists patients in applying for disability benefits when applicable.

11. Monitors EPIC work queues assigned and meets daily/weekly productivity standards.

12. Escalates issues to leadership timely.

Physical Requirements:

1. Frequent sitting, occasional standing & walking, and lifting of 5-10 lbs

2. Mental requirements will be intense at times with involvement in many concurrent multi-faceted projects

3. Requires manual dexterity using fine hand manipulation to operate a computer keyboard or related equipment

4. Requires ability to see computer screen, monitoring equipment and reports

Skills & Abilities:

1. Knowledge of hospital and medical terminology experience.

2. Familiarity with third party plans and medical billing.

3. Experience with hospital information systems.

At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.

The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.

Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth—one of the many ways we invest in you so you can thrive both at work and outside of it.

Pay Range: