Patient Assistance Counselor

JOB SUMMARY

The Patient Assistance Counselor is responsible for the accurate and timely assessment of uninsured and underinsured patient referrals to determine eligibility for financial assistance programs. This individual is responsible for conducting patient outreach and enrollment activities, reviewing, and processing financial assistance applications, and determining eligibility based on established criteria. The Patient Assistance Counselor ensures accurate documentation of patient interactions, calculates household income and assets to determine award levels, and collaborates with internal teams and external partners to facilitate timely support. By maintaining comprehensive records and monitoring program participation, this role helps ensure patients receive the financial resources necessary for their care. Additionally, the Patient Assistance Counselor contributes to process improvement initiatives and supports special projects aligned with organizational goals.

ESSENTIAL JOB FUNCTIONS

• Documents patient interactions conducted via phone or in person, detailing actions taken to ensure accurate and timely recordkeeping for future reference.
• Conducts outreach and enrollment activities to connect patients with available healthcare coverage, medication assistance programs, and grants, collaborating with internal teams and external partners to meet patient referral needs.
• Reviews financial and medication assistance applications for completeness and verifies alignment with established program requirements and eligibility criteria.
• Assists in the approval or denial of financial assistance applications within delegated authority limits to support timely and accurate processing.
• Screens patients for program eligibility, calculates income and assets, and determines financial assistance awards; documents interactions accurately to maintain complete records.
• Calculates household income and asset totals to determine appropriate award levels in accordance with established financial assistance protocols.
• Assesses patient eligibility for external financial support programs and monitors participation to ensure ongoing access to assistance.
• Maintains accurate and up-to-date records of financial assistance applications, financial documentation, and patient correspondence.
• Maintains strict adherence to scheduled work hours with regular and reliable attendance.
• Performs other duties as assigned.

EDUCATION AND EXPERIENCE

• High school diploma or equivalent.
• Minimum of two years of experience in a medical business office, healthcare setting, or comparable environment required.
• Proficient in Microsoft Office Suite.
• Knowledge of basic business math principles, including calculations and percentages with ability to interpret financial statements and tax returns.

CERTIFICATIONS / LICENSES

• Certified Application Counselor (CAC) designation through the Centers for Medicare and Medicaid Services required within three months of the first available CAC training period after hire. Employees hired fewer than three months prior to the CAC training period may defer certification until the following year. Preferred certification at time of hire.
• Employees must pass the CAC certification exam within three attempts and within three months of completing training. Failure to pass may result in termination, except in cases of extenuating circumstances.
• Valid Wisconsin Driver’s License required with an acceptable motor vehicle record (MVR), per FHC guidelines.

Equal Employment Opportunity