Patient Financial & Eligibility Specialist
Indexed description
POSITION SUMMARY: As a key member of the Revenue Cycle Management upstream team, the Patient Financial & Eligibility Specialist is a critical role with primary responsibility for verifying eligibility and benefits for all incoming patient per insurance plan, audit and review patient demographic and insurance information for accuracy. The position will work with the admission department and the patients to create financial agreement based on stated plan benefits and patient responsibility. The Patient Financial & Eligibility Specialist will work closely with the Billing & Collections Manager as well as the Dir of Admission to ensure cohesion with the admission process regarding payer source and information gathered.
ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE:
- Call insurance companies to obtain eligibility & benefits for substance abuse/behavioral health services for all incoming clients.
- Obtain & gather benefit details such as coverage level, exclusions, patient responsibility such as co-pays, deductibles, co-insurance and/or out of pocket maximums.
- Provide expertise in verifying insurance policies, eligibility criteria, and plan benefit details.
- Develop and maintain relationships with payors, facility providers, UR staff, and other stakeholders of the RCM process.
- Accurately fill out VOB forms with all necessary information for a proper admission process
- Complete and return benefits request in a concise and clear manner with detailed information on patient benefits & responsibility.
- Works directly with the clients and/or payers to determine client responsibilities prior to admission.
- Complete client financial responsibility agreements which specify client’s and/or other responsible parties’ responsibility for point of service cash collection.
- Counsel clients and/or responsible parties throughout the treatment continuum.
- Provide patient financial counsel around patient payment plans, track and monitor timely point of service cash collections on all payment plan & agreement.
- As needed assist with downstream patient account receivables post discharge collection.
- Effectively monitor the verification process during the upstream process of the patient claim life cycle.
- Support and promote Northpoint’s core values, mission and treatment philosophy.
- Maintain confidentiality in accordance with established policies and procedures and standards of care.
- Adhere to all Company policies and procedures.
- Perform other job-related duties as assigned.
- 3+ years of experience in medical and/or behavioral health setting required
- 1+ year of experience working with Medicaid and commercial medical insurance billing required
- Demonstrated knowledge of the technical aspects of revenue cycle management
- Strong understanding of CPT and ICD-10/DSM5 and payer plan benefits
- Strong knowledge of insurance and managed care plans to include benefits structures
- Must be self-starter, self-motivated, organized and detail oriented
- Demonstrated ability to develop both internal and external working relationships
- Proven skills in working independently on several projects concurrently
- Excellent critical thinking skills and organizational abilities
- Excellent communication skills: ability to communicate clearly and concisely, verbally and in writing
- Quickly and effectively identify and resolve problematic situations
- Comfortable analyzing information and dealing with complexity
- Attention to detail and accuracy
- Able to handle confidential material in a reliable manner
- Ability to interact and communicate with individuals at all levels of organization
- Ability to perform several tasks concurrently with ease and professionalism
- Ability to effectively prioritize workload in a fast-paced environment
- Proficiency with Microsoft Office Suite
Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.
Northpoint is an Equal Opportunity Employer. Northpoint is an at-will employer. Employment may be terminated at any time by employee, or employer with or without notice.
Compensation:: $23 USD - $25 USD
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