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.

ESSENTIAL FUNCTIONS 

1. Conduct face-to-face and telephonic interviews to obtain demographic, insurance, and financial information.
2. Manage complex, high-dollar, and at-risk accounts, including uninsured, underinsured, and self-pay patients.
3. Perform advanced insurance verification, benefit analysis, and comprehensive insurance discovery to identify all potential coverage sources.
4. Lead Medicaid eligibility screening, enrollment, and conversion efforts, ensuring uninsured patients are evaluated and assisted through the full application process.
5. Guide patients through Medicaid application completion, documentation collection, submission, and follow-up to ensure timely approvals and reimbursement.
6. Monitor Medicaid pending accounts and proactively resolve barriers to approval, including missing documentation, eligibility discrepancies, and agency follow-up.
7. Serve as a subject matter expert for Medicaid, Marketplace enrollment, and hospital financial assistance programs.
8. Provide Marketplace enrollment guidance, including education and plan selection in compliance with federal and state regulations.
9. Lead preparation, validation, and delivery of Good Faith Estimates (GFEs), ensuring accuracy, compliance, and alignment with the No Surprises Act.
10. Act as the escalation point for GFE discrepancies, patient disputes, and billing variances.
11. Drive point-of-service collections through accurate estimates, financial counseling, and strategic patient engagement.
12. Calculate estimated patient responsibility using advanced understanding of benefits and contractual obligations; drive point-of-service collections and secure compliant payment arrangements.
13. Provide onsite customer service by addressing patient billing inquiries, explaining financial responsibilities, and resolving payment-related concerns in a professional and patient-centered manner.
14. Perform patient cashiering functions, including collecting payments, processing transactions, issuing receipts, and ensuring accurate reconciliation in accordance with hospital financial policies and audit standards.
15. Evaluate accounts for financial assistance and charity care eligibility; initiate and facilitate application processes to mitigate financial risk system wide.
16. Analyze accounts to identify financial risk, coverage gaps, and opportunities to reduce bad debt and increase reimbursement.
17. Collaborate with Case Management, Patient Access, Scheduling, Billing, and external partners to resolve complex financial barriers.
18. Ensure accurate documentation and data integrity within Expanse to support clean claim submission and reduce denials.
19. Monitor and track outcomes related to Medicaid conversions, insurance discovery, financial assistance approvals, GFE accuracy, and reimbursement performance.
20. Identify trends, root causes, and revenue leakage; recommend and implement corrective actions.
21. Serve as a liaison between patients, hospital departments, payers, vendors, and governmental agencies to facilitate financial resolution.
22. Support and mentor team members by providing guidance, training, and knowledge sharing.
23. Participate in and lead workflow optimization and process improvement initiatives to improve efficiency, compliance, and financial outcomes.
24. Assist leadership with reporting, audits, and data analysis to support strategic decision-making.
25. Contribute to the development and refinement of financial clearance policies, procedures, and best practices.
26. Conduct patient interviews to obtain and validate demographic, insurance, and financial information.
27. Provide advanced financial counseling, clearly communicating benefits, out-of-pocket costs, coverage options, and financial expectations.
28. Prepare, review, and deliver compliant Good Faith Estimates for uninsured and self-pay patients.
29. Calculate patient financial responsibility and secure payments or establish compliant payment arrangements.
30. Evaluate patients for all available coverage options, with a strong emphasis on Medicaid eligibility and enrollment opportunities.
31. Provide advanced financial counseling on benefits, out-of-pocket costs, and coverage pathways.
32. Assist patients with Medicaid application completion, submission, renewal, and ongoing case management, ensuring continuity of coverage.
33. Maintain detailed account documentation and ensure accuracy across all systems.
34. Escalate high-risk accounts and unresolved issues appropriately.
35. Collaborate with interdisciplinary teams to support financial clearance and discharge planning.

DCH Standards: 

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.

• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.

• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.

• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

QUALIFICATIONS

Required:

• High School Diploma or GED.
• Minimum of 1+ years of hospital-based financial counseling, patient access, or revenue cycle experience or 3 years of customer service

Preferred:

• HFMA or equivalent revenue cycle certification.
• Medicaid Assistor certification or experience with state enrollment systems.
• Experience mentoring staff or leading process improvement initiatives.
• knowledge of Medicaid eligibility, enrollment processes, and program requirements, as well as Medicare, Marketplace plans, and financial assistance programs.
• Experience in insurance verification, benefit analysis, and financial counseling

Other Skills:

• Strong analytical, problem-solving, and communication skills.
• Ability to maintain accuracy and attention to detail while handling high-volume workloads.
• Demonstrated ability to work independently while collaborating with cross-functional teams.
• Strong analytical, problem-solving, and critical thinking skills
• Effective communication and interpersonal skills.
• Must be able to read, write legibly, speak, and comprehend English.

WORKING CONDITIONS

Work Context

• Working indoors in a cubical area, sitting 80% of the time, standing 5%, kneeling 2.5%, squatting/crouching 2.5%, stooping 5%, and walking 5%. Activities include lifting of 35 lbs maximum which would be a two (2) man lift, frequent lifting and/or carrying 20 lbs. occasionally.  Ability to push or pull over carpet floors, concrete ramps and on varied surfaces, a four-wheel cart with 50 lbs. of paperwork.
• Filing ledgers or finding ledgers requires reaching, pushing, pulling, extending the hands and arms in any direction. Stooping and bending the body forward by bending the spine at the waist.  To reach lower areas requires kneeling by bending the legs at the knee of crouching by bending the body downward and/or forward by bending the legs and spine.  This is 50% of daily work.
• Organizing charts requires handling of papers by holding, grasping and turning, with picking up and pinching as finger movements. This is a repetitious procedure that is constantly being done.
• Communication through talking, expressing and exchanging ideas by means of the spoken word. Hearing; perceiving the nature of sounds by the ear in order to communicate.  Seeing; use of vision to determine characteristics of objects, depth perception, color vision with the ability to distinguish color, coding on ledgers, near/far activity 100% daily.
• Ability to figure complex computations and communicate these figures to the public.
• Ability to maintain patient confidentiality 100% of the time.
• Must be able to perform the duties with or without reasonable accommodation.
• Hearing and vision must be normal or corrected to within normal range.
• Physical presence onsite is essential.