Insurance Cost Estimate Representative

Department/Unit:

Patient Access

Work Shift:

Day (United States of America)

Salary Range:

$46,947.00 - $65,726.00The Insurance Discovery and Insurance Cost Estimate Representative, AMHS has skill set encompassing strong working knowledge of third-party payer regulations; interpretation of payer contracts and applying contractual agreement to ensure payment and accurate estimates. Ability to be the liaison for challenging encounters requiring more than average time to resolve, to permit staff to manage workload. Work collaboratively with the Enrollment Service partner to ensure timely disposition for Medicaid Pending encounters.

Essential Duties and Responsibilities

• Review all self-pay encounters to identify insurance or determine referral to Enrollment Service Partner

• Assess challenging encounters from Out of State, International to secure payment source

• Provide accurate estimates in support of the No Surprise Act, Good Faith Estimates guidelines and Financial Aid Policy.

• Ability to provide explanation to patients of insurance benefits and self-pay estimates, including collection of balances owed.

• Ability to review, assess and reconcile Medicaid Pending inventory to ensure timely disposition.

• Review and determine, based on eligibility response, benefits and coverage to ensure 100% coverage for inpatient and outpatient services.

• Ability to explain to Clinic Staff, Outside Providers, and Patients financial responsibility and associated policies and legislation supporting patient’s financial responsibility and expected payment guidelines.

• Supports department operations as needed to ensure all encounters are financially secured prior to discharge.

• Support colleagues across the Albany Med Health System to ensure workload expectations are met as a team and not as individual contributors.

• Contributes to the creation of a compassionate and caring environment for patients, families and colleagues through displays of kindness and active listening. Recognizes and appreciates that each employee’s work is valuable and contributes to the success of the Mission.

Qualifications

• Associate's Degree - required

• Bachelor's Degree - preferred

• 3 – 5 years working knowledge of third-party payer regulations; healthcare financial counseling and Hospital or Physician office experience; in lieu of degree 5 – 7 years experience - required

• Exceptional knowledge of insurance discovery strategies including payer portals.

• Knowledge of Hospital Financial Law specific to No Surprise Act and Good Faith Estimate legislation.

• Demonstrated critical thinking skill to successful resolution

• Proven customer service skill with ability to exceed expectations with sensitive patient interactions

• Analyze encounter history to secure financial responsibility.

• Ability to multi-task in stressful and high patient volume unit; must be able to manage pressure of very tight timeframes to execute task

• Ability to remain composed under pressure

• Ability to review information and draw appropriate conclusion

• Good judgement and ability to be resourceful to problem solve; escalate issues as needed

• Team minded worth ethic

• Demonstrated ability interpret patient’s insurance benefits and apply the applicable contractual obligations

• Critical thinking ability regarding issues with financially securing payment

• Ability to discuss sensitive concepts with patients regarding financial obligations

• Ability to understand complex billing processes

• Medical Terminology

• CHAA - Certified Healthcare Access Associate within 1 Year - required

Equivalent combination of relevant education and experience may be substituted as appropriate.

Physical Demands

• Standing - Occasionally

• Walking - Occasionally

• Sitting - Frequently

• Feeling - Occasionally

• Talking - Frequently

• Hearing - Frequently

• Repetitive Motions - Frequently

• Eye/Hand/Foot Coordination - Rarely

Thank you for your interest in Albany Med Health System!​

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.