Patient Benefit Advisor

Company: Beaumont Hospital, Royal Oak (Mich.)
Location: Taylor
Posted on: May 16, 2023

Job Description:

GENERAL SUMMARY: Under general direction of the Patient Access Manager - Benefits Advisor, this position is responsible for assisting uninsured and underinsured patients and their families in researching and securing potential funding for services provided; including but not limited to Medicaid, Medicare SSI, and any other federal, state, Beaumont based, grants, and local programs, marketplace, auto, and other 3 rd party liability payers. Performs duties at acute hospital sites, and ambulatory sites. Utilizes knowledge of billing and payer rules to facilitate determination of potential resources and seamless processing of paperwork. Works with Beaumont staff and other providers to recommend referral of patients to appropriate sites for care.

ESSENTIAL DUTIES:

• Manages the process to ensure that all Benefit Advisors are educated and trained in identifying patients who are uninsured and underinsured. Offers alternatives and assists with application process for Medicaid, Health Michigan, Financial Assistance and Market Place exchange plans. Works with third party vendors on complex cases as directed by department policy.
• Advises patients and/or family members of their financial obligation via all modes of communication, including face-to-face communication while in the facility.
• Obtains payment in full or secures adequate payment arrangements/eligibility and benefit information for both inpatient and outpatient services. Advises patients on expenses associated with admission. Secures payments or payment arrangements on self-pay accounts. Discusses third party coverage with patient and arranges disposition of out of pocket balances due. Informs patients of payment requirements as soon as possible for inpatient preferably prior to discharge.
• Advises patients as to their financial liability and assists with insurance issues and activation of coverage.
• Administers collection program on international and cosmetic patients as directed per hospital policy to collect pre-payments.
• Utilizes Charge Master, EPIC price estimator, and business tools to provide cost estimates for complex procedures, surgeries, and ancillary testing and ensures information is received from patients and physicians.
• Provides superior customer service to the patient and family by assisting with completion of required paperwork and program applications, such as for Medicaid and the Beaumont Charity and Financial Assistance Programs.
• Serves as a resource to Patient Accounting staff, Social Workers, and other staff for identification of funding sources for health services for patients.
• Explains and assists with all discount programs as they relate to the patient's financial responsibility.
• Communicates with other institutions relative to any prior patient service.
• Attends hearings at the state and local level, as needed.
• Assists with the discharge process to extended care facilities as it relates to the patient's financial responsibility.
• Identifies hospital, public, and / or private financial assistance programs for patients unable to meet their financial obligations. Collaborates with Social Services, clinical staff, and / or outsourcing company to assist patients / families in completing assistance program applications and determining eligibility and coverage. Inputs data into electronic database(s) and completes daily reports timely and accurately.
• Documents all activities with patients, families, insurers, D.H.S. workers and providers regarding financial assistance needs.
• Continually works with management in Business Operation Support to improve the efficiency of data collection as well as ALL customer satisfaction.
• Provides departments with ongoing feedback to ensure compliance with third party payer regulations.
• Interacts with other third-party vendors, and Case Management, Detroit Wayne County Health Authority, and D.H.S. workers to assure a timely, efficient and accurate financial case.
• Attends department staff meetings and in-services to maintain current knowledge. Keeps up to date with all department standards to assure compliance with state and federal regulations. Responsible for training new employees and instructing current employees of process changes.
• Special projects as assigned.
  
  STANDARD QUALIFICATIONS
  
  

• High school diploma or equivalent.
• Associate degree or four (4) years of equivalent experience in business or related field.
  • 2-3 years' experience working with government entitlement programs (e.g., Medicaid) in a previous financial counseling or third-party billing role preferred.
  • Previous Medicaid application processing experience highly desirable.
  • Six to ten years of patient accounting, medical billing, or non-clinical healthcare experience preferred. Knowledge of ICD-9 coding preferred.
  • Experience working with the public is required.
  • Previous Medicaid application processing experience is highly desirable.
    
    Other Qualifications :
    
    • Demonstrated self-starter. In-depth knowledge of Medicare & Medicaid regulations and other insurance plans.
    • Excellent oral, written and interpersonal communication skills; medical terminology, and excellent organizational skills.
    • Ability to quickly assess and respond appropriately to emergency situations.
    • Ability to comprehend medical terms.
    • Analytical skills to resolve complex problems requiring the use of scientific, mathematical or technical principles, and in depth experienced based cross-functional knowledge.
    • Knowledge and experience with a variety information systems and Internet usage; experience with spreadsheet and word processing software.
    • Ability to work independently and manage individual workload to meet productivity standards along with a varied schedule, which includes weekend and evening coverage.

Keywords: Beaumont Hospital, Royal Oak (Mich.), Taylor , Patient Benefit Advisor, Other , Taylor, Michigan