Financial Counselor

Job Summary 

The Financial Counselor is responsible for the timely and accurate follow-up and resolution of unpaid patient balances. This position manages a high volume of patient interactions related to self-pay accounts, analyzes patient responsibility, obtains and verifies insurance information, establishes payment arrangements, and processes patient payments. The Financial Counselor serves as a billing representative, resolving patient financial concerns that may impact a patient’s ability to receive services. 

Key Responsibilities 

• Respond to a high volume of incoming patient calls related to self-pay statements, billing inquiries, and payment concerns. 
• Initiate outbound collection calls to patients on an ongoing basis in a professional and customer-focused manner. 
• Review and monitor assigned accounts and collection reports to ensure timely follow-up and resolution. 
• Analyze self-pay balances to determine patient financial responsibility, including deductibles, coinsurance, and contractual discounts. 
• Establish and monitor payment arrangements and provide timely follow-up on agreed payment plans. 
• Process patient payments accurately and in accordance with company procedures. 
• Research accounts deemed potentially non-collectible and prepare them for referral to collection agencies as appropriate. 
• Ensure all available payment resources have been researched and exhausted prior to escalation. 
• Identify billing issues requiring further review (e.g., claim corrections, appeals) and communicate findings to appropriate billing staff through documented patient cases. 
• Handle billing loop calls and respond to inquiries from patients, physician offices, and insurance companies. 
• Resolve patient billing problems while maintaining excellent customer service and preserving patient relationships. 
• Address patient concerns in a calm, courteous, and professional manner, including interactions with dissatisfied patients; escalate concerns to the Quality Department as needed. 
• Meet established productivity metrics and key performance indicators (KPIs). 
• Maintain compliance with HIPAA and all company plans, policies, and procedures set forth by Orthopaedic Solutions Managemet. 
• Perform reports, projects, and other duties as assigned. 

Education and Experience  

• High School Diploma or GED required. 
• Minimum of 5 years of prior medical billing experience or equivalent required. 
• Working knowledge of CPT and ICD-10 coding required. 
• Demonstrated understanding of Explanation of Benefits (EOBs) and reimbursement practices, including deductibles, coinsurance, and contractual adjustments. 

Preferred Qualifications & Skills  

• Strong knowledge of insurance guidelines and payer requirements. 
• Excellent customer service skills with the ability to handle sensitive financial conversations. 
• Strong attention to detail with a high level of accuracy. 
• Effective verbal and written communication skills. 
• Ability to work independently with minimal supervision while meeting goals, deadlines, and performance metrics. 
• Ability to manage multiple tasks in a deadline-driven environment. 
• Professional, well-presented, and tactful demeanor. 
• Ability to work collaboratively as part of a team and meet the expectations of internal and external customers.