Counselor-Finance

Baptist Memorial Health Care; Memphis (TN); On-site; USD 40,000 - 55,000; Full time

Job summary

Baptist Memorial Health Care is seeking a Financial Counselor to coordinate patient financial responsibilities for treatments such as chemotherapy and other services. You will be responsible for verifying medical necessity and assisting patients in navigating financial assistance programs.

The ideal candidate must possess excellent communication skills, relevant experience in healthcare, and the ability to handle high-stress situations effectively. This role is crucial for ensuring patients receive the care they need within their financial means.

Qualifications

• 5 years of business experience in a healthcare environment preferred.
• 3 years of business-related office experience with 1 year in healthcare required.
• Ability to understand medical policies and guidelines.

Responsibilities

• Obtain and review treatment plans for medical necessity according to guidelines.
• Collect deductibles and co-pays, setting up payment plans.
• Assist self-pay patients with the Baptist Financial Assistance Program.

Skills

Clear and effective communication

Ability to multi-task

Problem-solving skills

Basic computer skills

Education

Associate’s degree or 2 years of college courses

CHAA certification

Job description

Summary

The Financial Counselor ensures that chemotherapy (specialty group) and other infusions/radiation therapy/radiology/surgical services meet medical necessity and appropriateness per insurance medical policies/FDA/NCCN guidelines. Initiates and coordinates pre-certifications/prior-authorizations per payer guidelines before services are rendered. The Financial Counselor counsels patients regarding their financial responsibility for treatment, educates and initiates enrollment in third party assistance programs that reduce patients’ out-of-pocket expenses. Initiates enrollment in the Baptist Financial Assistance Program for self-pay patients and serves as a liaison between the patient and the Patient Assistance Team. Collects deductibles, co‑insurance and prior balances and initiates payment plans. Performs other duties as assigned.

Responsibilities

• Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
• Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services. Utilize multiple healthcare websites.
• Review patient medical records and identify necessary information for pre‑certification for confirmation of medical necessity.
• Track, obtain, and extend authorizations from various carriers in a timely manner.
• Meet with new patients to provide patient‑specific education on their insurance benefits and estimated out‑of‑pocket expenses for their prescribed therapy prior to treatment initiation.
• Work with patients and caregivers to collect deductibles and co‑pays and set up payment plans.
• Obtain necessary consent forms and financial documents from patients and providers to initiate applications for copay assistance and PAP drug programs.
• Assist self‑pay patients with initiating applications for the Baptist Financial Assistance Program.
• Work closely with physicians and clinic staff to promote positive patient outcomes and timely treatment.
• Understand and comply with regulatory requirements by specific insurance companies and facilitate compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff.
• Perform other duties as assigned.

Education & Qualifications

• Preferred: Associate’s degree or 2 years of college level courses.
• Minimum: Skill in communicating clearly and effectively using standard English in written, oral, and verbal format to achieve high productivity and efficiency.
• Skill to write legibly and record information accurately as necessary to perform job duties.
• Preferred: 5 years of business experience in a healthcare environment. Front‑end collections experience desired.
• Minimum: 3 years of business‑related office experience with 1 year being healthcare related.
• Preferred: CHAA certification.
• Preferred: Knowledge of oncology pre‑certification requirements and guidelines.
• Minimum: Ability to read and understand medical policies, compendiums, LCDs, and FDA guidelines. Must be able to multi‑task and be flexible. Basic computer skills, ability to perform basic math computation, type 25 words per minute, and problem‑solving skills. Ability to handle confrontational issues and high‑stress situations with patients, family, and physicians.