Patient Insurance Benefit Specialist I

Summary

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    

1. 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.
2. 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.     
3. 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.
4. Handles all patient questions and concerns regarding possible processing of insurance claims, benefits and financial assistance eligibility prior to appointment.
5. Reviews and may complete authorizations and referral requests.  Communicates with utilization management department as necessary to ensure that services are authorized.  
6. Prescreens for potential financial assistance for Colorado Indigent Care Program (CICP) and/or National Jewish Financial Assistance Program (NJFAP) based on applicable policies.  
7. 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.  
8. Serve as the PFS Customer Service Representative to the Patient Financial Services Department.  Providing excellent customer service to patients, co-workers, and clinical staff.  
9. Maintains appropriate level of knowledge regarding NJH clinical operations.

Other Duties    

1. Maintains appropriate level of expertise with the HIS, EMR, eligibility software, scheduling software, scanning software, merchant software, and vendor systems.     
2. Communicates regularly with Supervisor or Manager regarding high-risk accounts.  Identifies and refers problematic workflow trends to Supervisor for evaluation and solution.  
3. Provides supervisor with weekly productivity statistics and reports workload fluctuations (backlog or shortages) in a timely manner.
4. May be called as back up for the following; available to meet with patients, scheduled and unscheduled, in the Patient Finance Office. Directs patients to appropriate departments as needed. Answers a multitude of questions regarding billing, financial impacts, benefits, referrals, authorization, services, estimates, etc., as well as addressing concerns and complaints.  

Competencies    

1. Accountability: Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to National Jewish Health. 
2. Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
3. Attention to Detail: Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.
4. Building Trust: Interacting with others in a way that gives them confidence in one’s intentions and those of the organization.
5. Collaboration/Teamwork: Cooperates with others to accomplish common goals; works with employees within and across his/her department to achieve shared goals; treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.
6. Customer Focus: Ensuring that the customer perspective is a driving force behind business decisions and activities; crafting and implementing service practices that meet customers’ and own organization’s needs.
7. Initiative: Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.

Supervisory or Managerial Responsibility    

None

Travel    

None

Core Values    

1. Be available to work as scheduled and report to work on time.
2. Be willing to accept supervision and work well with others.
3. Be well groomed, appropriately for your role and wear ID Badge visibly.
4. Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
5. Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution.
6. Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures. 
7. Wears appropriate PPE as outlined by the infection control policies and procedures.
8. Demonstrates compliance with all state, federal and all other regulatory agency requirements.

Minimum Qualifications

1. Education: High school diploma or equivalent required. Associate’s degree preferred.
2. Work Experience: A minimum of 1 year experience in financial counseling, patient financial services or insurance follow up in a healthcare or health insurance environment in any aspect of the revenue cycle process required.
3. Special Training, Certification or Licensure: None

Salary Range: $19.00 - $23.00

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.

• Medical Plans, Dental Plans and Vision Insurance
• Retirement Plan
• FSA and HSA
• Short and Long Term Disability
• Life Insurance and AD&D
• Voluntary Benefits, like Accident Insurance, Critical Care and Hospital Indemnity
• Sick and Vacation Paid Time Off
• Wellness Program
• Legal Plan