Patient Financial Advisor

Job Summary:

• The Financial Counselor is responsible for providing financial counseling services to patients across the hospital and affiliated clinics by identifying appropriate funding sources, verifying insurance benefits, determining eligibility for financial assistance programs, and facilitating point-of-service collections. This position works collaboratively with Patient Access, Centralized Scheduling, Surgery Scheduling, Business Office, and clinical departments to ensure patients are financially cleared prior to services whenever possible while promoting positive patient experiences and maximizing reimbursement opportunities.
• The Financial Counselor also provides remote support to the Young County Family Clinic (YCFC), Orthopedic Clinic, General Surgery Clinic, and other specialty clinics by assisting uninsured and underinsured patients with self-pay accounts, sliding fee scale eligibility, financial assistance applications, Medicaid screening, and payment arrangements.

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Supervisory Responsibilities:

• None 

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Duties/Responsibilities:

• Interview patients to assess financial needs and identify appropriate funding sources.
• Verify insurance eligibility, benefits, and coverage through payer portals and eligibility systems.
• Educate patients regarding insurance benefits, estimated out-of-pocket expenses, co-payments, deductibles, co-insurance, and payment expectations.
• Calculate and communicate estimated patient financial responsibility prior to services whenever possible.
• Collect co-payments, deductibles, deposits, prior balances, and self-pay balances before services are rendered in accordance with hospital policy.
• Establish payment arrangements for qualified patients following hospital guidelines.
• Assist patients with Financial Assistance, Charity Care, Medicaid, Marketplace, and other governmental assistance applications.
• Determine eligibility for Sliding Fee Scale programs for qualifying clinic patients.
• Provide remote financial counseling support for Young County Family Clinic (YCFC), Orthopedic Clinic, General Surgery Clinic, and other specialty clinics.
• Collaborate with Centralized Scheduling and Surgery Scheduling to ensure elective procedures are financially cleared prior to scheduled services.
• Review surgery and outpatient schedules to identify patients requiring financial counseling before services are rendered.
• Work closely with Registration staff to resolve insurance, demographic, and financial issues prior to service.
• Verify and update patient demographic, guarantor, and insurance information within the electronic health record.
• Ensure accurate insurance selection, coordination of benefits, and billing information.
• Document all patient interactions, financial counseling activities, payment arrangements, and account actions in the patient accounting system.
• Monitor assigned accounts through completion of the financial assistance or eligibility determination process.
• Assist Business Office staff with denial prevention by resolving eligibility, insurance, and patient responsibility issues.
• Serve as a resource to patients and staff regarding billing questions, financial assistance policies, insurance coverage, and payment options.
• Maintain positive working relationships with patients, physicians, insurance companies, government agencies, and hospital departments.
• Identify opportunities to improve financial counseling workflows, patient access processes, and point-of-service collections.
• Participate in departmental meetings, quality improvement initiatives, continuing education, and required training.
• Maintain compliance with all federal, state, payer, and hospital regulations, policies, and procedures.
• Assist with bedside financial counseling and other Patient Access responsibilities as assigned.
• Cross-train within Patient Access and Revenue Cycle functions to ensure operational continuity and eliminate single points of failure.
• Perform other related duties to benefit the mission of the organization.

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Required Skills/Abilities: 

• Excellent customer service and interpersonal communication skills.
• Strong verbal and written communication skills.
• Ability to interview and counsel patients regarding financial matters with professionalism, empathy, and confidentiality.
• Strong analytical, organizational, and problem-solving skills.
• Ability to prioritize multiple tasks while maintaining accuracy in a fast-paced environment.
• Ability to work independently and collaboratively with multidisciplinary teams.
• Proficiency in Microsoft Office applications and healthcare information systems.
• Ability to maintain confidentiality in accordance with HIPAA, Texas HB 300, and HITECH requirements.
• Strong attention to detail and commitment to accuracy.

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Job-related Skills and Abilities: 

• Knowledge of hospital revenue cycle operations and patient access workflows.
• Knowledge of Medicare, Medicaid, commercial insurance, workers' compensation, managed care, and self-pay billing processes.
• Knowledge of insurance verification, benefit determination, prior authorization, and financial clearance procedures.
• Knowledge of financial assistance, charity care, Medicaid eligibility, and Sliding Fee Scale programs.
• Ability to interpret insurance benefits and explain financial obligations to patients.
• Ability to utilize electronic health records, patient accounting systems, insurance websites, and eligibility tools efficiently.
• Basic understanding of medical terminology.
• Ability to identify opportunities to improve point-of-service collections and reduce uncompensated care.
• Ability to develop positive working relationships with internal departments and external agencies.

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Education and Experience:

• High school diploma or equivalent required.
• Associate's degree in Business, Healthcare Administration, Finance, or related field preferred.
• Minimum of two (2) years of experience in Patient Access, Financial Counseling, Revenue Cycle, Insurance Verification, Hospital Registration, Medical Billing, or related healthcare field preferred.
• Experience determining eligibility for government assistance programs, financial assistance, or charity care preferred.
• Experience working within a Critical Access Hospital or rural healthcare environment preferred.
• Experience supporting surgical scheduling, centralized scheduling, or outpatient services preferred.

     Preferred Certifications

• Certified Healthcare Access Associate (CHAA)
• Certified Revenue Cycle Representative (CRCR)
• Certified Patient Account Technician (CPAT)

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Physical and Mental Requirements: 

• Prolonged periods of sitting at a desk and working on a computer.
• Frequent standing and walking throughout hospital departments and clinic locations.
• Must be able to lift and carry up to 25 pounds occasionally.
• Frequent bending, reaching, twisting, and stooping.
• Ability to travel between departments and affiliated clinics as needed.
• Frequent use of hands and fingers for typing, writing, filing, and operating office equipment.
• Visual acuity sufficient to review medical records, insurance information, and computer screens.
• Hearing sufficient to communicate effectively in person and by telephone.
• Ability to manage multiple priorities while maintaining attention to detail.
• Ability to maintain professionalism and composure during stressful patient interactions.
• Stress Level: Moderate 

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OSHA Classification: 

• Category II: Tasks that involve no exposure to blood, body fluids or tissues but employment may require performing unplanned Category I tasks.
• The normal work routine involves no exposure to blood, body fluids or tissues, but exposure may be required as a condition of employment. Appropriate protective measure, such as gloves, masks, goggles, and gown are readily available to every employee engaged in Category II tasks.