SUMMARY 

The Financial Counselor is responsible for initiating and coordinating pre-certification and prior authorization for patients with their insurance carrier, to provide financial counseling to patients, and to work closely with the business office to ensure timely claim and account follow up.

MINIMUM QUALIFICATIONS

Education and Experience:

• High school diploma or GED required
• Experience and/or training, including customer service; or equivalent combination of education 
• Experience with medical terminology, medical insurance experience preferred
• One year of experience in business, ophthalmic/medical billing, patient collections and coding preferred

ESSENTIAL SKILLS AND ABILITIES

• Coordinate with the patient, physician, insurance company, and hospital on the complete precertification process, including second opinions and tertiary referrals.
• Make and answer telephone calls from patients and insurance companies regarding the precertification process.
• Process additional information requests and coordinate with the insurance biller on requests for letters of medical necessity from and to insurance companies.
• Receive and process insurance information and forms from patients and insurance companies.

• Review provider schedules, checking patients’ accounts for outstanding insurance claims over 60 days and communicating with the biller to request additional claim follow up.
• Have knowledge of surgery package prices and clinic prices for self-pay and out of pocket expenses to utilize when speaking with patient 
• Establish payment arrangements with the patient and document appropriately in the practice management system

• Discuss payment arrangements with patients for outstanding patient balances.
• Work with pharmaceutical companies and other resources to obtain grants and financial aid for patients in need.

• Work with Wells Fargo and Care Credit to provide financing arrangements with patients who qualify.

Perform other duties as assigned.

• Must have proficient computer skills
• Must have a complete hands-on working knowledge of NexTech software or related medical billing software
• Must have an understanding of Medicare, Medicaid and Commercial Insurance
• Must have a working knowledge of ICD-9 and CPT codes for ophthalmology
• Must be able to problem solve
• Must be detailed oriented
• Must have excellent communication skills, proper grammar and writing capability
• Must have a working knowledge of all forms associated with the patient medical record (paper and electronic)
• Must be able to collect balances due from patients
• Must be team-oriented
• Must be self-directed, highly motivated, able to multi-task, work under pressure in a fast paced environment
• Must be able to accurately and efficiently handle multiple projects at one time 
• Must have exceptional interpersonal skills
• Must possess a caring, patient and friendly attitude
• Prefer an understanding of ophthalmic terminology, spelling and pronunciation 
• Prefer a general understanding of ophthalmic diseases

DUTIES AND RESPONSIBILITIES

1. Monitors changes in insurance plans and policies.  Inform management of such changes on an immediate basis
2. Provide financial counseling to patients regarding procedures, surgeries, patient past due balances
3. Collects and properly posts any pre-payments, deductibles, co-pays and balances due from patients within 24 hours
4. Properly informs management/physician of the patient’s inability to pay for services rendered
5. Establishes outside financing or internal payment plans for patients as needed
6. Properly post all outside financing to include finance charges as required by management
7. Answers all incoming telephone calls from patients regarding billing/collection matters in a timely and efficient manner
8. Accurately post payments from the patient visit within 24 hours
9. Verify and document cash collected
10. Reconcile all cash, credit cards and balance postings to encounters and payments
11. Enters memos on patient ledger regarding information sent or received from insurance patients
12. Professional and Personal Development/Goals and Objectives
1. Exhibits professional demeanor with a positive enthusiastic attitude at all times when representing the practice
2. Maintains certification, where applicable, and continues to improve skills
3. Must attend all in-services and webinar training seminars as directed by the Accounts Receivable Manager
4. Sets goals and objectives for professional growth.  Reviews and revises goals on an ongoing basis
5. Provides input on how to improve customer service, decrease costs and increase revenues for the practice
13. Customer Service
1. Supports the practice core values and mission statement to develop, enhance and promote quality customer service through team effort
2. Exhibits flexibility, sensitivity and respect while maintaining an effective working relationship with all team members
14. Maintains practice confidentiality, follows HIPAA/OSHA guidelines and follows the rules and regulations of the practice as documented in the practice employee manual
15. Assumes other duties as assigned

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• The majority of the time on-the-job is spent walking, sitting, using hands to hold items and move items, reaching with hands and arms, talking, hearing, stooping, crouching and bending
• At times the job may require weight to be lifted up to 50 pounds
• The job requires the following types of vision:  close, distance, peripheral and depth perception
• Typical noise level for the work environment of this job is moderate (i.e. business office with computers and printers, light traffic)
• Working in an office environment with sustained posture in a seated position for extensive periods of time
• Must be able to communicate clearly in person and over the telephone
• Hearing must be adequate to perform job duties in person and over the telephone
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

SUPERVISORY RESPONSIBILITIES: None

OTHER

This job description is intended only to describe the general nature and level of work performed.  The Financial Counselor must be able to travel to various satellite locations as needed for work assignments. A valid Florida driver’s license is required. This job description is not intended nor should it be interpreted as an exhaustive list of all duties, skills and responsibilities. The Financial Counselor will perform all duties listed in this job description as well as any other assigned by management. Overtime may be required.