Senior Financial Counselor (PFS)

POSITION SUMMARY:

The Senior Financial Counselor plays a critical role in ensuring patients who require financial counseling receive timely, accurate, and effective support to access healthcare coverage. The position exists to support patient access to care while contributing to BMC's revenue cycle through accurate registration and financial eligibility processes. The role functions across both centralized and decentralized patient care settings and supports clinical operations as needed.

Working under the general supervision of the Supervisor of Financial Counseling, the Senior Financial Counselor assists uninsured and underinsured patients in obtaining coverage through available programs, including MassHealth, Out of State Medicaid, Health Safety Net, Medicare-related programs, and the BMC's Charity Care Program. The role provides patient advocacy and continuity of support to facilitate application completion, eligibility determinations, and appeals when applicable.

The Senior Financial Counselor is responsible for supporting consistent, compliant financial counseling practices that align with BMC's mission, vision, and values, as well as applicable billing, collection, and regulatory requirements. As a certified SHINE counselor, the role provides free, health insurance information and counseling to Medicare-eligible patients and caregivers across inpatient and outpatient settings, including managing a high volume of financial counseling cases from initial engagement through resolution.

Position: Senior Financial Counselor

Department: Financial Counseling

Schedule: Full Tim

ESSENTIAL RESPONSIBILITIES / DUTIES

• Assist uninsured and underinsured patients in obtaining healthcare coverage through MassHealth, Medicaid, Health Safety Net, Connector Care, Medicare programs, and BMC's Charity Care Program. Facilitate applications, appeals, and eligibility notifications, and provide guidance on cost-saving options.
• Educate patients in understanding Medicare Part D, Medigap, Senior Care Options (SCO), and Medicare Savings Programs, and provide referrals to external resources such as Boston ElderINFO.
• Serve as a resource to patients and staff regarding insurance eligibility, SHINE program options, and payor enrollment/disenrollment.
• Maintain Certified Application Counselor and SHINE certifications, including completing required curriculum, annual recertifications, and monthly activity requirements.
• Participate in departmental meetings, trainings, and SHINE leadership meetings to support continuous improvement and collaboration.
• Conduct full registration and verify patient insurance using established methods.
• Ensure accuracy of patient demographic, insurance, and admission data in BMC's information system.
• Contact patients by phone, email, mail, or with interpreter services to obtain applications, consent forms, and verification documents.
• Facilitate applications, appeals, and written notifications of eligibility determinations.
• Document accurate information on patient accounts, update coverage and billing indicators, and track pending applications until final disposition.
• Use work queues, protected software, and reporting tools to identify self-pay accounts and monitor pending applications.
• Track applications to completion, close financial trackers, and ensure compliance with regulatory and hospital standards.
• Identify opportunities to obtain retroactive coverage when appropriate and respond to billing inquiries by advising patients on payment plans, discounts, and charity care options.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

Job Requirements

REQUIRED EDUCATION AND EXPERIENCE:

• High school Diploma/GED

• Minimum of 3 years of experience in financial counseling and hospital registration; or an equivalent combination of education and experience.

PREFERRED EDUCATION AND EXPERIENCE:

• Bachelor's Degree preferred

CERTIFICATIONS, LICENSES, REGISTRATIONS REQUIRED:

• MassHealth's Certified Application Counselor (CAC)
• Serving the Health Insurance Needs of Everyone (SHINE) certification

KNOWLEDGE, SKILLS & ABILITIES (KSAs):

• Knowledge of healthcare coverage programs, including MassHealth, Health Safety Net, ConnectorCare, Charity Care, and Medicare-related coverage, with the ability to accurately apply program rules to determine eligibility and guide enrollment.
• Skill in financial counseling case management, including tracking and managing a high volume of cases using work queues, worklists, and financial systems to support timely and accurate outcomes.
• Ability to meet established productivity and outcome goals, including quality and performance metrics associated with SHINE certification and financial counseling services.
• Skill in obtaining, verifying, and maintaining accurate patient information, including demographic, financial, and visit-specific data, to ensure data integrity and compliance.
• Analytical and problem-solving ability to identify and resolve barriers related to patient enrollment, eligibility, documentation, or access to coverage programs.
• Ability to manage competing priorities effectively, maintaining accuracy, productivity, and adherence to departmental, regulatory, and compliance requirements.
• Ability to work independently under general supervision and collaboratively with cross-functional teams to support financial counseling and departmental objectives.
• Strong written and verbal communication skills, including the ability to explain complex insurance information clearly and maintain accurate documentation.

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, and licensure/certifications directly related to position requirements. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Equal Opportunity Employer/Disabled/Veterans

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