National Patient Financial Counselor

Description

Job Summary :

The National Patient Financial Counselor is responsible for assisting patients in navigating their health insurance options through both the Health Insurance Marketplace and Medicaid programs. This includes determining potential eligibility, supporting patients through the application process, guiding them in selecting a Marketplace Plan or Medicaid Managed Care Organization (MCO) without directing them toward a specific plan, and assisting with renewals / revalidations to help maintain continuous coverage.

The National Patient Financial Counselor also handles key patient financial responsibilities, including reconciling balance journals, processing verified patient reimbursement requests, and responding to patient and facility inquiries regarding balances.

The National Patient Financial Counselor must demonstrate exceptional patience, empathy, and professionalism while helping patients navigate sensitive financial and healthcare matters.

Essential Functions :

• Assist patients with understanding and navigating the Health Insurance Marketplace and Medicaid application processes, including eligibility, enrollment, and renewals.
• Provide education on Health Insurance Marketplace and Medicaid Managed Care Organization (MCO) options and support patients in making informed decisions.
• Conduct patient interviews to collect necessary information for insurance and payment assistance programs.
• Offer ongoing support post-enrollment to help maintain patient coverage.
• Document patient interactions and maintain accurate records for reporting and compliance.
• Communicate effectively and compassionately with patients, insurance companies, and internal teams.
• Address patient balance inquiries, process refunds, reconcile accounts, and collaborate with clinics on account resolution.
• Work closely with internal teams to ensure coordinated patient support and accurate financial management.
• Perform special projects and other duties as needed. Assist with special projects by utilizing Excel / Google spreadsheets and communicate results.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Other duties as assigned by the management team.

Supervisory Responsibilities :

(Scope of the person's authority, including a list of jobs that report to this job)

None

Essential Qualifications :

(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).

Education / Licensure / Certification :

High school graduate or equivalent

Required Knowledge :

Minimum of 1 year of experience in customer service, with demonstrated skills in reading and interpreting balance journals, managing insurance accounts receivable, and assisting patients

with health coverage enrollment, including applications for the Health Insurance Marketplace or Medicaid..

Experience Required

2+ years experience in customer service, with demonstrated skills in reading and interpreting balance journals, managing insurance accounts receivable, and assisting patients with health

coverage enrollment, including applications for the Health Insurance Marketplace or Medicaid..

Skill and Ability :

Knowledge of insurance policies, CPT and ICD10, and payer requirements.

Excellent communication and interpersonal skills, with the ability to interact effectively with patients, payers, and clinical staff.

Detail-oriented with strong organizational and problem-solving skills.

Strong understanding of and ability to use software and systems, including but not limited to electronic medical record systems, Microsoft Office, and Google Docs / Sheets; daily use of laptop / computer for email, note taking, and other tasks required.

Prefer bilingual in English and Spanish

Job or State Requirements

HS diploma or equivalent