Financial Counselor
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- Remote
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About US Eye: US Eye is a physician-led, patient-centric network of eye care practices committed to providing exceptional patient service through premium technology and unrivaled provider expertise. We are one of the nation’s leading multi-specialty physician groups providing patients with care in ophthalmology, optometry, dermatology, and facial surgery. With 50 clinics and five surgery centers, led by 95 providers and more than 1,000 team members system-wide, we deliver world-class care to patients throughout Florida, the Carolinas, and Virginia.
JOB SUMMARY:
Financial Counselors primary duties are to focus on determination of patient estimate calculations, and pre-service collection. Financial Counselors are responsible for assisting patients with any financial questions, concerns, or options they would like to pursue before and after treatment. Financial Counselors may be required to provide coverage on the secondary duties relating to Insurance Verification and Authorization.
PRIMARY DUTIES:
Financial Counseling - Patient Estimation, Calculation & Pre-service Collections
Patient estimation & pre-service collections
- Verify insurance eligibility and benefits for all appointments staying a minimum of a week ahead of scheduled service.
- Calculate out of pocket patient responsibility utilizing Rivet or other estimation tools to determine patient cost.
- Generate accurate, real-time (“on-the-fly”) cost estimates for office visits, diagnostics, injections, and surgeries using payer information and practice fee schedules.
- Place outgoing calls to patients to address patient responsibility amounts due prior to appointment.
- Coordinates patients’ assistance applications for specific procedures when applicable, to include financing options for patients.
- Document financial counseling activities in NextGen.
- Customer service (Internal & External)
- Answers calls via the financial counselor phone queue and responds to emails from staff / providers.
- In person or remote counseling
- Prior balance verification-to include entering copays and/or deductibles for consult visits, in-office procedures, and surgeries.
- Adherence to applicable laws, regulations, and contractual obligations. Follows the principles of the Compliance Program as well as the Code of Conduct.
SECONDARY DUTIES:
Verification
- Eligibility verification
- Verify eligibility as active staying a minimum of a week ahead of scheduled service.
- Verify eligibility as active for add-on appointments, staying ahead of schedule and verifying eligibility the same day for services scheduled and performed on the same day.
- Use NextGen to identify and correct inactive or incorrectly registered policies and address.
- Utilize payer websites for further verification when needed.
- Contact patients to update / obtain correct information when needed.
- Validate that the correct plan was chosen per the insurance guide and provide feedback to supervisor for feedback to upstream areas.
- Confirm network participation and advise patient of our provider’s network participation when needed.
- Forward new plans to supervisor for payer file updates.
- Document verification activities in NextGen to support productivity and quality tracking.
- Ensure NextGen system is updated.
Authorization & PCP Referrals
- Obtain authorizations, referrals, pre-determinations, or any other payer pre-service approval as needed, staying a minimum of seven days ahead of scheduled service, and ensuring that authorization, referral, or pre-determination is obtained for add on appointments in advance or on the same day of service.
- Obtain vision plan authorizations.
- Obtain PCP referrals for HMO’s and provide feedback to supervisor on any particularly difficult or timeconsuming PCP offices.
- Obtain prior authorization or pre-determination as needed for clinic and facility services.
- Obtain prior authorization for procedures as required by insurance plans.
- Review MDI Pending notifications for imaging orders and obtain prior authorization for those which need approval.
- Coordinates patients’ assistance applications for specific procedures when applicable, to include financing options for patient.
- Document authorization, referral, pre-determination activities in NextGen.
OTHER DUTIES AND RESPONSIBILITIES:
During non-peak times, providing additional RCM Support within other departments (i.e., patient assistance – enrollments, shipments, and replacement drugs), A/R Support (Claim status for unresponded to claims, review and outreach to patients with large outstanding balances and accounts in pre-list status, targeted denial management).
COMPETENCIES:
- Expertise in insurance verification, authorization management, financial clearance and AR billing functions. Strong analytical skills for identifying and resolving charge posting, payment errors and payer denials.
- Excellent written and verbal communication with a compassionate, patient-centered approach.
- Proficiency with EHR and billing platforms (e.g., NextGen and Intellichart Pro, etc). Exceptional attention to detail, organization, and multitasking ability in a fast-paced environment.
PREFERRED EDUCATION AND EXPERIENCE:
- Bachelor’s Degree
REQUIRED EDUCATION AND EXPERIENCE:
- A high school graduate or equivalent
- Proficient in computer and typing
- Knowledge of Microsoft Office products (Word, Excel)
- Excellent customer service skills in phone, person or via email
- Ability to manage multiple, ongoing tasks while maintaining professional composure.
- Have an understanding of insurance and medical terminology.
Please note this job description is not designed to cover or contain a comprehensive list of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
PHYSICAL DEMANDS:
- Prolonged periods of sitting at a desk and working on a computer.
- The noise level in the work environment is usually moderate.
- Moderate lifting 10-50lbs
- Hybrid role
- Ability to travel between locations as necessary
WORK ENVIRONMENT:
The work characteristics described here are representative of those an employee encounters while performing the
essential functions of this job. Fast-paced, deadline oriented, confidential department. The noise level in the work
environment is usually moderate.
POSITION TYPE AND EXPECTED HOURS OF WORK:
This is a full-time position. Days and hours are Monday through Friday 8:00 A.M. – 5:00 P.M. with occasional
overtime.
TRAVEL:
Travel may be required.
