Patient Benefits Advisor 2 - Full Time - Bascom Palmer Eye Institute (Miami, FL)

University of Miami•Miami, FL

3d•Onsite

About The Position

The Patient Benefits Advisor 2 ensures patients have adequate insurance coverage for services and advises them about gaps in coverage so payment arrangements can be made. The role reviews scheduled services, insurance coverage, prior balances, and payment history; prepares detailed estimates; and advises patients and guarantors about healthcare costs, insurance coverage, and expected out-of-pocket expenses. The advisor helps patients meet financial obligations by discussing payment plans and alternate payment sources, and guides those seeking financial assistance through the application process. The position also obtains and documents prior authorizations, updates patient insurance information, submits referral documentation, processes telephone credit-card payments in accordance with PCI security standards, and follows up on pending payments and accounts. It collaborates with clinical departments, providers, insurers, and government agencies to resolve account issues, documents collection efforts, provides statements, and supports compliance with applicable policies and procedures. The advisor trains new team members and serves as a subject-matter resource for coworkers and internal customers.

Requirements

High school diploma or equivalent.
Minimum 2 years of relevant experience.
Strong customer service skills.
Strong written and verbal communication skills.
Highly detail-oriented and organized.
Excellent interpersonal skills.
Knowledge of medical terminology.

Responsibilities

Greet individuals by phone or in person with a warm, professional greeting.
Coordinate with scheduling departments when prior authorizations have not been obtained or have been denied.
Assist departments with inquiries about account status, pre-certification, eligibility, financial estimates, and department policies and procedures.
Protect patient information and dispose of paperwork appropriately to preserve confidentiality.
Obtain and fully document prior authorizations before services are received.
Contact physician offices to obtain missing patient information.
Use patient estimate tools and insurance company contacts to prepare accurate out-of-pocket estimates, document them, and generate estimate letters.
Update patient accounts with correct insurance information.
Submit insurance referral documentation in a timely manner.
Review schedules to identify uninsured or under-insured patients and patients with previous balances.
Review scheduled services, insurance coverage, previous balances, and payment history, and create detailed estimates.
Develop global packages for self-pay patients or guarantors within 1 to 3 business days to support CMS compliance.
Make outbound calls or meet with patients and guarantors to explain healthcare costs, insurance coverage, and expected out-of-pocket costs, and provide detailed estimates.
Offer payment plans or identify alternate payment sources for patients requesting financial assistance before the date of service.
Provide financial-assistance applicants with a plain-language summary, explain the process, and refer them to MyChart to complete the charity application and upload required documents.
Assign financial-assistance flags, create or open cases in the Financial Assistance Module, and upload documents supplied by patients.
Process telephone credit-card payments in accordance with PCI security standards and monitor and follow up on pending deposits and payments.
Maintain collaborative working relationships with other departments, providers, insurance companies, and federal, state, or local agencies to help patients and guarantors meet financial obligations.
Provide statements in accordance with established policies and procedures.
Strive to meet or exceed individual and departmental key performance indicator goals.
Clearly document collection efforts in the system and follow up on accounts until resolved.
Liaise and collaborate with the On-site Patient Access Team, CBO, and clinical departments to resolve charge or outstanding-balance discrepancies.
Train new Patient Benefit Advising team members on procedures and systems and serve as a subject-matter resource for coworkers and internal customers.
Perform other duties as assigned.
Adhere to University and unit-level policies and procedures and safeguard University assets.