The Patient Benefits Advisor is a fundamental part of the patient experience and is a key contributor to the financial health of the organization. The Benefits Advisor coordinates all aspects of the financial clearance process to provide a seamless, transparent and centralized source for patients and families, particularly those whose care spans multiple services. This includes but is not limited to pre-registration, insurance eligibility and benefit management, medical necessity screening, prior authorization management, financial counseling and payment conversion planning. Further, the incumbent shall work with patients and families to financially secure outpatient services, out/inpatient procedures and inpatient admissions; informing, educating and financially counseling patients on their insurance benefits, out of pocket expenses and the options available for payment and/or assistance. Analyzing data from multiple disparate systems and platforms, the Advisor will pre-screen services, work with providers and payers to authorize care, ensure medical necessity and where applicable manage federal and commercial waivers for out of pocket billing. Where applicable, the Advisor will work with providers to reschedule, escalate for approval and/or cancel unsecured services where medical necessity and authorization cannot be obtained. The Advisor is additionally accountable to secure hospital transfers, urgent and emergent admissions, authorizing and tracking all payer sources and in the case of births, ensure parents enroll newborns in their insurance plan. The Advisor will be expected to distill complex regulatory and payer requirements into succinct, easy to understand language, thereby ensuring patients make informed care decisions with a full understanding of their financial obligation. The Benefits Advisor must maintain excellence in customer service and guest relations at all times, ensuring that all those who come to the organization experience a positive encounter pre-service and at time of service.
Bachelor’s Degree preferred, Associates required. An equivalent combination of education and experience may be substituted. CHAA certification preferred and required within one year of employment.
Position requires one or more years of experience as a Patient Access Specialist, Biller, Financial Counselor, Advocate and/or enrollment specialist, insurance specialist or highly skilled customer service focused role where skills are immediately applicable.