Clinical Financial Counselor

Summary

Initiate and coordinate 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.

Examples of Work

Job functions are specific duties that would be included in the essential functions of the job description. These functions are not all-inclusive nor do they cover the full extent of the duties performed.

• Coordinates with the patient, physician, insurance company and hospital on the complete pre-certification process, including second opinions and tertiary referrals.
• Makes and answers telephone calls from patients and insurance companies regarding the pre-certification process.
• Processes additional information requests and coordinate with the insurance biller on requests for letters of medical necessity from and to insurance companies.
• Receives and processes insurance information and forms from patients and insurance companies.
• Reviews provider schedules, checks patients’ accounts for outstanding insurance claims and communicating with the biller to request additional claim follow up.
• Reviews patient therapy protocols and determine insurance benefits and patient responsibility.
• Establishes payment arrangements with the patient and document appropriately in the practice management system.
• Discusses payment arrangements with patients for outstanding patient balances.
• Processes oral medication prescriptions for potential office dispensing.
• Works with pharmaceutical companies and other resources to obtain grants and financial aid for patients in need.

Education and Experience

High school diploma and one year of related experience and/or training, including customer service; or equivalent combination of education and experience.

Licensure and Certification

None

Supervision

None

To see common career pathways for each position at the University of Florida please visit the Career Paths section of the UFHR website.