Patient Insurance Benefit Specialist I

Position Summary

Evaluates patient’s potential financial liability prior to medical services being rendered, by telephone and electronic / standard mail. This includes working with patients and their families to evaluate insurance benefits, financial data. Determines cost estimates, ability to pay, potential denials, negotiates payment arrangements, deposits and screening for hospital and state financial assistance programs.

Essential Duties

• Performs insurance verifications via, automated eligibility checks, payor sites, and / or contacting insurance companies by phone as needed for mostly program patients. This includes obtaining and documenting covered and non-covered benefits, plan type, copayments, co-insurance, out of pocket, deductible amounts and determining coverage for services at NJH.
• Has a complete understanding of health insurance, NJH contracted payors and how benefits may apply to the many services provided by NJH. This includes a general knowledge of provider types, place of service, and how services are billed, i.e., facility claim, physician claims in order to give accurate information to payors and patients.
• 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.
• Handles all patient questions and concerns regarding possible processing of insurance claims, benefits and financial assistance eligibility prior to appointment.
• Reviews and may complete authorizations and referral requests. Communicates with utilization management department as necessary to ensure that services are authorized.
• Prescreens for potential financial assistance for Colorado Indigent Care Program (CICP) and / or National Jewish Financial Assistance Program (NJFAP) based on applicable policies.
• Maintains some 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 PFS policy as needed.
• Serve as the PFS Customer Service Representative to the Patient Financial Services Department. Providing excellent customer service to patients, co-workers, and clinical staff.
• Maintains appropriate level of knowledge regarding NJH clinical operations.

Other Duties

Competencies

Supervisory or Managerial Responsibility

None

Travel

None

Core Values

Minimum Qualifications

Salary Range : $20.69 - $27.36

Benefits

At National Jewish Health, we recognize that our outstanding faculty and staff are the essence of our organization. For every aspect of health care, our employees are our greatest asset. With that in mind, we have designed a valuable, comprehensive benefits package to meet the needs of our employees and their families.

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