Lead Financial Counselor

Position Summary

The Lead Financial Counselor is a Certified Application Counselor (CAC) who serves as a senior member of the Enrollment and Revenue Integrity Department. Working closely with the Financial Counselor Supervisor, this position provides operational support, subject matter expertise, and guidance to the Financial Counseling team in assisting patients with obtaining health insurance coverage, navigating public benefit programs, and accessing financial assistance resources.

In addition to managing complex patient cases, the Lead Financial Counselor promotes quality, accuracy, consistency, and compliance across financial counseling activities. This role serves as a resource for staff, leads training and onboarding efforts to ensure team competency and adherence to established workflows, and provides ongoing coaching and support to enhance staff performance. The Lead Financial Counselor also proactively manages and monitors the BACO list to identify patients who may be eligible for financial assistance or insurance enrollment, ensuring timely outreach and follow-up to support patient access and optimize reimbursement opportunities. This position models exceptional customer service and cultural sensitivity while contributing to organizational goals related to patient access, revenue optimization, and financial sustainability.

Primary Responsibilities

Leadership & Supervision

• Guide and support the daily operations of the Enrollment/Financial Counseling team.
• Assign tasks, monitor productivity, and conduct quality assurance reviews.
• Act as first point of escalation for complex cases, insurance workflows, and patient concerns.
• Lead team meetings, communicate policy updates, and report key performance metrics.
• Support staff development through coaching, mentoring, and performance evaluations.

Training & Development

• Coordinate onboarding and training for new Financial Counselors, Patient Service Representatives, Unit Coordinators, and Call Center.
• Develop, maintain, and update Financial Counseling training materials, standard operating procedures (SOPs), job aids, and reference guides.
• Serve as the department's subject matter expert for Financial Counseling processes, insurance enrollment programs, and financial assistance resources.
• Lead and facilitate training sessions for Financial Counseling staff and other organizational departments on topics related to insurance coverage, public benefits, financial assistance programs, enrollment workflows, and patient financial services.

Patient Financial Services

• Provide direct financial counseling and insurance enrollment assistance to patients.
• Assess eligibility and assist with applications for MassHealth, Health Connector plans, Medicare, and other public benefit programs.
• Educate patients regarding insurance coverage, financial responsibility, available assistance programs, and payment options.
• Review and work the Sliding Fee Scale work queue to ensure timely processing of applications, renewals, and follow-up activities
• Determine eligibility for sliding fee discounts and establish payment arrangements in accordance with organizational policies.
• Review self-pay accounts and work queues to identify opportunities for insurance coverage, financial assistance, and payment collection.
• Collaborate with third-party organizations, including BridgeHealth and other community partners, to coordinate patient outreach efforts, facilitate access to available resources, and support continuity of care.

Revenue Cycle & Strategic Support

• Ensure accurate and timely documentation of insurance, eligibility, and financial information within the electronic medical record (EMR).
• Collaborate with Revenue Cycle, Billing, and Registration teams to resolve account issues, denials, and payment plan concerns.
• Monitor departmental performance related to quality, productivity, enrollment outcomes, financial assistance approvals, and collections.
• Support organizational initiatives designed to improve patient access, health equity, and financial performance under value-based care models, including Accountable Care Organizations (ACOs).

Community Engagement & Outreach

• Conduct outreach to increase awareness of Codman Health Access Programs (CHAP).
• Support community events promoting enrollment in insurance and public assistance programs.

Other duties and/or locations as assigned

Requirements

Education

• Associate's degree required; bachelor’s degree preferred.

Certification

• CAC (Certified Application Counselor) required.
• Preferred: CPC (Certified Professional Coder) or CCA (Certified Coding Associate).

Experience

• Minimum 3 years of experience in Revenue Cycle or Patient Financial Services.
• Minimum 2 years in a supervisory or lead role.
• Experience working in FQHC or community health settings preferred.

Technical Skills

• Proficient with EPIC/OCHIN EMRs and Microsoft Office Suite.
• Familiar with billing codes (CPT, ICD-10, HCPCS) and reimbursement guidelines.

Core Competencies

• Strong leadership and communication skills.
• Excellent analytical, problem-solving, and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Demonstrated cultural sensitivity and commitment to exemplary customer service.
• Bilingual (Spanish or Haitian Creole) strongly preferred.

Physical Requirements

• Must be able to stand or sit for prolonged periods (50% of the time) ·
• Must be able to lift 10-25 pounds and load onto shelves.
• Visual acuity sufficient for frequent reading and computer use.