Overview
SUMMARY
The Financial Counselor – Financial Clearance is a hospital-based revenue cycle position responsible for securing reimbursement, reducing uncompensated care, and ensuring financial clearance prior to service delivery, patient discharge, and post-discharge follow-up.
This role leads eligibility screening, insurance verification, benefit analysis, point-of-service collections, and patient financial counseling to ensure patients understand their financial responsibilities while supporting the hospital’s revenue cycle performance.
The Financial Counselor serves as a subject matter expert in Medicaid eligibility and enrollment, insurance coverage, financial assistance programs, and regulatory compliance, including the No Surprises Act and Good Faith Estimate (GFE) requirements. This role ensures patients receive timely and accurate financial disclosures while mitigating organizational compliance and financial risk.
This position functions as a key liaison between patients, hospital departments, payers, vendors, and governmental agencies, driving financial clearance outcomes, improving reimbursement, reducing bad debt, and enhancing the overall patient financial experience.
By securing financial clearance prior to services and identifying coverage opportunities, this role helps protect hospital revenue, reduce bad debt exposure, and improve financial transparency for patients.
Responsibilities
ESSENTIAL FUNCTIONS
Conduct face-to-face and telephonic interviews to obtain demographic, insurance, and financial information.
Manage complex, high-dollar, and at-risk accounts, including uninsured, underinsured, and self-pay patients.
Perform advanced insurance verification, benefit analysis, and comprehensive insurance discovery to identify all potential coverage sources.
Lead Medicaid eligibility screening, enrollment, and conversion efforts, ensuring uninsured patients are evaluated and assisted through the full application process.
Guide patients through Medicaid application completion, documentation collection, submission, and follow-up to ensure timely approvals and reimbursement.
Monitor Medicaid pending accounts and proactively resolve barriers to approval, including missing documentation, eligibility discrepancies, and agency follow-up.
Serve as a subject matter expert for Medicaid, Marketplace enrollment, and hospital financial assistance programs.
Provide Marketplace enrollment guidance, including education and plan selection in compliance with federal and state regulations.
Lead preparation, validation, and delivery of Good Faith Estimates (GFEs), ensuring accuracy, compliance, and alignment with the No Surprises Act.
Act as the escalation point for GFE discrepancies, patient disputes, and billing variances.
Drive point-of-service collections through accurate estimates, financial counseling, and strategic patient engagement.
Calculate estimated patient responsibility using advanced understanding of benefits and contractual obligations; drive point-of-service collections and secure compliant payment arrangements.
Provide onsite customer service by addressing patient billing inquiries, explaining financial responsibilities, and resolving payment-related concerns in a professional and patient-centered manner.
Perform patient cashiering functions, including collecting payments, processing transactions, issuing receipts, and ensuring accurate reconciliation in accordance with hospital financial policies and audit standards.
Evaluate accounts for financial assistance and charity care eligibility; initiate and facilitate application processes to mitigate financial risk system wide.
Analyze accounts to identify financial risk, coverage gaps, and opportunities to reduce bad debt and increase reimbursement.
Collaborate with Case Management, Patient Access, Scheduling, Billing, and external partners to resolve complex financial barriers.
Ensure accurate documentation and data integrity within Expanse to support clean claim submission and reduce denials.
Monitor and track outcomes related to Medicaid conversions, insurance discovery, financial assistance approvals, GFE accuracy, and reimbursement performance.
Identify trends, root causes, and revenue leakage; recommend and implement corrective actions.
Serve as a liaison between patients, hospital departments, payers, vendors, and governmental agencies to facilitate financial resolution.
Support and mentor team members by providing guidance, training, and knowledge sharing.
Participate in and lead workflow optimization and process improvement initiatives to improve efficiency, compliance, and fi