Infusion Financial Counselor

Job Description – Infusion Financial Counselor

Classification – FSLA - Non-Exempt - hourly

Salary Grade/Level/Range Level of experience, longevity, within current company pay structure.

Reports to Revenue Cycle Manager

Position Summary

The Infusion Financial Counselor is responsible for proactively managing financial risk and patient financial engagement for high-cost neurology infusion therapies (e.g., MS, AD, MG, CIDP, NMO and related autoimmune conditions).

This role focuses exclusively on infusion-related financial clearance, assistance program optimization, structured payment arrangements, and cumulative exposure monitoring to protect the practice’s buy-and-bill margin while supporting continuity of medically necessary care.

This position requires advanced knowledge of insurance benefits, specialty drug reimbursement, copay assistance programs, and patient financial counseling.

Key Responsibilities

1️⃣ Pre-Infusion Financial Clearance

• Perform 48-hour insurance eligibility and benefit verification
• Confirm active authorizations and units remaining
• Calculate estimated patient responsibility (deductible/coinsurance)
• Identify high financial exposure cases
• Flag RED accounts prior to drug ordering
• Coordinate clearance using traffic light model

2️⃣ Financial Risk Management

• Monitor cumulative unpaid infusion balances
• Identify repeated high-risk (RED) patients
• Escalate cases to leadership when thresholds are exceeded
• Participate in structured case reviews with VP, Revenue Services and Medical Director
• Maintain infusion financial dashboard and reporting metrics

3️⃣ Patient Financial Counseling

• Conduct in-office and telephonic financial consultations
• Explain insurance benefits and patient responsibility
• Implement structured payment agreements
• Secure deposits or auto-draft arrangements when required
• Document all financial discussions in EMR/billing system

4️⃣ Assistance Program Optimization

• Manage manufacturer copay assistance programs
• Monitor foundation grant availability
• Track copay max-out and accumulator impact
• Assist with Medicaid eligibility screening when appropriate
• Ensure financial documentation compliance

5️⃣ Collections Prevention

• Intervene prior to account placement in collections
• Re-engage patients with balances in collections when appropriate
• Monitor payment plan compliance
• Reduce repeat default patterns

6️⃣ Reporting & Leadership Support

• Provide monthly report including:
  • High risk exposure patients
  • Assistance capture rates
  • Cumulative unpaid infusion balances
  • Collections trends
• Present high-risk cases during leadership review meetings

Required Qualifications

• 3+ years experience in healthcare revenue cycle or financial counseling
• Experience with specialty pharmacy, buy and bill infusion services, and patient assistance programs
• Strong knowledge of:
  • Commercial insurance benefits
  • Medicare and Medicaid reimbursement
  • Deductible and coinsurance structures
  • Copay accumulator programs
• Experience with payment plan management
• Strong communication and conflict de-escalation skills
• Ability to handle sensitive financial conversations professionally

Preferred Qualifications

• Familiarity with autoimmune biologics (Ocrevus, Tysabri, IVIG, etc.)
• Understanding of prior authorization processes
• Experience managing foundation assistance programs
• Experience in the specialty of neurology
• Proficiency in EMR and billing platforms

Key Competencies

• Financial risk analysis
• High emotional intelligence
• Calm conflict management
• Attention to detail
• Independent decision-making within policy framework
• Executive-level reporting capability

Working Conditions

• Hybrid of desk-based administrative work and in-person patient counseling
• Frequent collaboration with infusion nurses, billing, and providers
• May require difficult financial conversations

Position Type/Expected Hours of Work
This is a full-time in-office position. Days and hours of work are Monday through Friday, 8:00 a.m. to 4:00 p.m.

• Travel – none

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employees should adhere to all approved policies, procedures and philosophies.

The employee signature below constitutes the employee’s understanding of the requirements, essential functions and duties of the position.