Position Summary: 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.
Essential Job Functions:
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.
All other duties as assigned
Knowledge: 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.
Experience: 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. College degree preferred or high school diploma (equivalent).
Competencies: 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.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhaustive list of responsibilities, duties and skills required.
About The Outsource Group:
Nationally headquartered in St. Louis, Missouri, with small, client-focused operations centers from coast to coast, The Outsource Group is the leading healthcare receivables management company in the country. We focus exclusively on providing services along the revenue cycle aimed at improving a hospitals cash flow.
Unlike other types of Accounts Receivable, healthcare A/R is unique, requiring an understanding of billing complexity, patient sensitivity, coordination of benefits, and knowledge of hospital revenue cycle processes, systems and payer requirements. Our approach to revenue cycle management, our level of professional staffing, and our service lines reflect that understanding.
We Are National in Scope With A Local Presence
The Outsource Group has grown both organically and through the acquisition of several best-in-class companies, each providing specific healthcare-focused solutions.
This business model enables us to provide the resources of a large company with the individualized service and flexibility of a smaller firm. Each of our centers of excellence serves a limited number of clients and is led by a client manager and operations manager who provide a high level of individualized services and greater flexibility.