Patient Financial & Eligibility Specialist

Northpoint Recovery Holdings•Meridian, ID

5d•$23 - $25•Hybrid

About The Position

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.

Requirements

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

Nice To Haves

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

Responsibilities

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.