Patient Insurance Benefit Specialist II

• Facility
  * National Jewish Health - Main Campus
• Schedule - Shift - Hours Full Time - Day Shift: Monday - Friday

Evaluates patient’s potential financial liability prior to and after medical services have been rendered. This includes working with patients and their families to evaluate financial data and determine ability to pay under all payors, negotiating payment arrangements and administering hospital and state financial assistance programs.

• Evaluates and communicates patient’s potential financial liability directly to the patient prior to medical services being rendered based on insurance verification data and medical cost estimates. Negotiates collection deposits of estimated co-insurance, co-pay and deductible amounts.
• Provides financial counseling by telephone, electronic/standard mail or face-to-face to patients/guarantors to ensure collectability of patient balances and/or accounts in compliance with federal and state laws regarding debt collection and hospital billing and collection policies. This includes securing patient payments by negotiating payment plans or arranging alternative settlement agreements.
• Administers hospital financial assistance policies and the Colorado Indigent Care Program (CICP). Audits and adjusts all charity accounts monthly. Interprets individual, self-employed and business financial statements to accurately rate a patient using the guidelines of the charitable programs.
• Evaluates patient financial applications for Colorado Medicaid eligibility. Assists patients with Colorado Medicaid application process.
• Maintains ability to read and comprehend all payors’ claims adjudication vouchers. Utilizes vouchers in order to perform comprehensive account audits as necessary on self-pay balance disputes, processing of patient refunds, payment transfers and adjustments in accordance with PBO policy.
• Handles all patient questions and concerns with regard to the processing of patient insurance claims and financial assistance eligibility. Performs self-pay and bad debt collection follow-up as assigned and in accordance with PFS policy.
• Serve as the PFS Customer Service Representative to the Patient Financial Services Department. Providing excellent customer service to patients, co-workers, and clinical staff. Greets customers on the telephone or in person, assesses needs and provides information and/or services requested. Directs patients to appropriate departments as needed.
• Performs Insurance verifications. Includes obtaining and documenting covered and non-covered benefits, plan type, copayments, co-insurance, out of pocket, and deductible amounts and determining contract and benefit eligibility. Contact insurance companies as needed.
• Reviews and may complete authorizations and referral requests. Communicates with utilization management department as necessary to ensure that services are authorized.
• Submit billings to pharmaceutical copay assistance programs for reimbursement of claims.
• Maintains a current and thorough working knowledge of third party payors processing in regards to medical management policy, provider contractual obligations, patient benefit levels, and payor specific insurance terminology.
• Maintains appropriate level of knowledge regarding NJH clinical operations.

• Maintains appropriate level of expertise with the HIS, EMR, eligibility software, scheduling software, scanning software, merchant software, and vendor systems.
• Establishes and maintains effective working relationships and customer service skills. Including patients, clients, co-workers, third party payors, NJH’s early out pre-collections (EOVC) and collection agency. Actively participates in team and departmental meetings by sharing ideas for improved work processes in PFS.
• Communicates regularly with Supervisor or Manager regarding high-risk accounts. Identifies and refers problematic workflow trends to Supervisor for evaluation and solution.
• Provides supervisor with weekly productivity statistics and reports workload fluctuations (backlog or shortages) in a timely manner.
• Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment;…