Retina Financial Counselor

Overview

Effective Date: 08/22/18, revised 03/08/21, 10/10/25, 12/05/25

Job Title: Retina Financial Counselor

Department: Corporate/BID

Reports To: Director, Financial Clearance

Type Of Position: Full-Time

FLSA Status: Non-Exempt

The Retina Insurance Coordinator verifies insurance eligibility and benefits for Retina doctors, obtains prior authorization, referral or pre-determination when needed, as well as provides support to patients through patient assistance programs. As needed, the Retina Insurance Coordinator may also be required to perform secondary duties relating to financial counseling, verification and authorization for non-retina specialties.

Primary Duties

• Verify insurance eligibility and benefits for all Retina Provider appointments to include injections, surgery, procedures, or office visit based upon the type of event scheduled.
• Maintaining retina schedule at a minimum of 14 days prior to date of service
• Obtain authorization, referral or pre-determination for the retina service that is scheduled.
• Patient estimation & pre-service collections, determining out of pocket amount due from patient for the retina service that is scheduled and contacting the patient in advance of the scheduled service to collect the patient responsibility amount.
• Notate copays, deductibles, and prior balances to be collected.
• Identify patients that may benefit from co-pay assistance and facilitate submission of application and shipping with various funding organizations.
• Document insurance eligibility verification and authorization, referral, or pre-determination activities in Next Gen appointment details and complete insurance verification templates.
• Document patient assistance activities in Next Gen tasking.
• Monitor services actually performed to identify if a different service was provided, so that an amended or new prior authorization, referral or pre-determination can be obtained.
• Answer Financial Counselor queue.
• Assist Clinical Teams with same day inquiries.
• Adherence to applicable laws, regulations, and contractual obligations. Follows the principles of the Company’s Compliance Program as well as the Code of Conduct.

Hybrid duties – travel assignment will be provided on a monthly basis

• Assisting the clinical staff with authorization and balance questions (approval to proceed with same-day drug changes or sample, etc.)
• Assisting the clinical staff with Valeda Light Therapy financing options, collecting payments from patients, scheduling patient appointments.
• Maintaining primary duties at least 80% of each scheduled day on-site.

Reasonable accommodations may be made to individuals with disabilities to perform the essential functions.

• Demonstrated ability to follow oral and written instructions.
• Demonstrated knowledge of material, methods, instruments and equipment.
• Demonstrated ability to read, write and perform mathematical calculations.
• Must be able to maintain high degree of confidentiality. Ability to multi-task, work in a fast-paced environment and manage time accordingly in order to meet deadlines and requirements of the organization.

The position has no supervisory responsibilities.

The work characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Fast-paced, deadline oriented, confidential department. The noise level in the work environment is usually moderate.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Demonstrated ability to do excessive walking, standing, bending and stooping. While performing the duties of this job, the employee is frequently required to stand, sit, use hands to handle or feel objects, tools or control, reach with hands and arms and talk or hear. The employee is occasionally required to climb or balance, kneel and crouch.

The employee may be required to lift moderately heavy objects (50-90 pounds). Specific vision abilities required by this job include close vision, distance vision, color vision,…