GENERAL SUMMARY OF DUTIES - Responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. The Benefits Advisor serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management. DUTIES INCLUDE BUT ARE NOT LIMITED TO:
- Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity application.
- Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment.
- Ensures appropriate signatures are obtained on all necessary forms.
- Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
- Complete and file applications.
- Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
- Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately.
- Document progress notes to the patient's file and the hospital computer system.
- Participates in ongoing, comprehensive training programs as required.
- Follows policies and procedures to contribute to the efficiency of the office.
- Covers and assists with other office functions as requested.
- Will be required to make field visits as necessary.
- Adheres to and supports organizational IT&S standards, policies, and procedures.
- Adheres to Code of Conduct.
- Performs other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES
- Working knowledge of medical terminology, practices and procedures, as well as laws, regulations, and guidelines.
- An understanding of patient confidentiality to protect the patient and the clinic/corporation.
- Demonstrated communication, problem solving and case management skills and the ability to act/decide accordingly.
- Ability to collect, synthesize and research complex or diverse information.
- Exceptional customer service and the ability to plan organize and exercise sound judgment.
- College degree preferred or high school diploma (equivalent).
- A minimum three years of hospital/medical business office experience with insurance procedures and patient interaction.
- Strong familiarity with a variety of the field's concepts, practices and procedures.