Financial Counselor (Insurance Verification & Eligibility)

About the position We are seeking an experienced Financial Counselor to support our patients by coordinating reimbursement sources and demystifying insurance benefits. Approximately 80% of this role focuses on verifying, interpreting, and explaining insurance coverage. The ideal candidate is a "benefits expert" who can navigate payer websites with ease and translate complex financial jargon into clear, supportive language for our patients. You will be the bridge between clinical care and financial clarity, ensuring our patients feel empowered rather than overwhelmed by their coverage.

Responsibilities

• Benefits Verification: Verify insurance eligibility using payer websites and online tools; ensure 100% accuracy of coverage details prior to and during treatment.
• Patient Communication: Clearly explain copays, deductibles, coinsurance, and out-of-pocket responsibilities to patients in a calm, compassionate manner.
• Escalation Management: Confidently lead difficult conversations and resolve escalated patient financial concerns with empathy and professionalism.
• Data Integrity: Accurately document all demographic and financial information to support clean claims and minimize downstream denials.
• Financial Solutions: Identify patient financial needs, establish payment plans according to Ophelia’s policies, and negotiate payment arrangements when necessary.
• Cross-Functional Collaboration: Partner with the billing and revenue cycle teams to improve processes and provide feedback on insurance trends.

Requirements

• Experience: 2–4 years of healthcare financial counseling or benefits verification experience
• Technical Expertise: Highly proficient in navigating insurance portals, payer websites, and online eligibility tools.
• The "Translator": You have a knack for making complex insurance rules easy for anyone to understand.
• Revenue Cycle Savvy: You have a working knowledge of the full revenue cycle and understand how benefit errors lead to claim denials.
• Startup Ready: You are adaptable, comfortable working across multiple systems (Google Workspace), and thrive in a growing, fast-paced environment.
• Detailed & Organized: You are a stickler for accuracy and can prioritize a high volume of tasks without losing focus.

Benefits

• Remote work anywhere in the United States
• Competitive medical, vision, and health insurance (many plans are fully covered for the employee!)
• Start with 20 days (4 weeks) of PTO, increasing to 5 weeks after 2 years and 6 weeks after 5 years of tenure
• One-time Work From Home Stipend
• 10 company holidays
• 401k Contribution Platform
• Additional benefits offered through our benefits provider such as life insurance, short and long term disability, financial wellness, virtual primary care, among others!

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