Health Insurance Specialist - Western Hematology & Oncology - Golden, CO
National Jewish Health/National Jewish Health - Western Oncology/Western Hematology
Full Time (40 hours per week)
Work Hours: 8:00 am - 5:00 pm
Req # 13234
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, 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 PBO policy.
- 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.
- Establishes and maintains effective working relationships and customer service skills. Including patients, clients, all co-workers, third party payors, NJH’s EOVC and collection agency. Actively participates in team and departmental meetings by sharing ideas for improved work processes in the PBO.
- 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.
- 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.
- Business Acumen: Using economic, financial, market, and industry data to understand and improve business results; using one’s understanding of major business functions, industry trends, and own organization’s position to contribute to effective business strategies and tactics.
- 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.
- 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.
- Peer Relationships: Interacts with others in a constructive, positive, and respectful manner, regardless of individual differences. Assists team members or co-workers in achieving personal goals and completing assignments.
Supervisory or Managerial Responsibility
- Be available to work as scheduled and report to work on time.
- Be willing to accept supervision and work well with others.
- Be well groomed, appropriately for your role and wear ID Badge visibly.
- Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
- Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution.
- Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures.
- Wears appropriate PPE as outlined by the infection control policies and procedures.
- Demonstrates compliance with all state, federal and all other regulatory agency requirements.
- Education: High school diploma or equivalent required. Associate’s degree preferred.
- Work Experience: A minimum of two (2) years of recent and related experience in financial counseling or healthcare required.
- Special Training, Certification or Licensure: None