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Patient Financial and Eligibility Specialist

3 months ago

Meridian, United States Northpoint Recovery Holdings, LLC Full time
Job DescriptionJob Description

Job Title: Patient Financial and Eligibility Specialist (Weekend Shift)

Reports To: Patient Financial and Eligibility Supervisor

Northpoint Recovery Holdings, LLC, established in 2009, is a growing, behavioral healthcare treatment platform treating adults with substance use disorder and co-occurring conditions under the Northpoint Recovery brand and adolescents with mental healthcare conditions under the Imagine by Northpoint brand. The Company serves patients with commercial health insurance and is an in-network model. Northpoint has grown from two facilities to fifteen today entirely on a de novo basis with plans to expand rapidly in both existing and new markets. Organizational values include humility, heart, inspiration and conviction. Our commitment to excellence means doing good for others and engaging in innovative empirical based treatment. In short, our mission is to help people get their lives back and show them respect and empathy in the process.

POSITION SUMMARY: As a key member of the Revenue Cycle Management upstream team, the VOB/PFS specialist is responsible for performing detailed insurance benefit verifications of all patients’ eligibility prior to claim submission to the carrier. This is an important role in identifying active coverage under the correct policy, while effectively communicating with third-party payers. This position will work with the Admissions department, and the patients, to create a financial agreement based on stated plan benefits and patient responsibility. The PFS Eligibility specialist will work closely with the Billing & Collections Manager as well as the Corporate Director of Admissions to ensure cohesion with the admission process regarding payer source and information gathered.

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:

  • Call insurance companies to obtain eligibility & benefits for substance use/behavioral health services for all incoming patients
  • Obtain & gather benefit details such as coverage level, exclusions, and patient responsibility including 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 seamless admission process
  • Complete and return benefits requests in a concise and clear manner with detailed information on patient benefits & responsibility
  • Work directly with the patients, and/or payers, to determine patient responsibilities prior to admission
  • Complete patient financial responsibility agreements which specify patient’s and/or other responsible parties’ responsibility for point of service cash collection
  • Counsel patients 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
  • Assist with downstream patient account receivables, and post discharge collection
  • Effectively monitor the verification process during the upstream process of the patient claim life cycle
  • Generate reports for analysis, trending, and subdivision of work to communicate with internal stakeholders
  • Meet productivity standards as set by RCM leadership
  • Educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes
  • Support and promote Northpoint’s core values, mission and treatment philosophy
  • KIPU experience preferred
  • Advanced MD experience preferred
  • Strong organizational skills with the ability to multitask
  • Familiarity with major payer guidelines
  • Meticulous attention to detail and high level of accuracy is key
  • 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

QUALIFICATIONS/REQUIREMENTS FOR POSITION:

  • Minimum of three (3) years of experience in medical and/or behavioral health setting
  • Minimum of one (1) year of experience working with Medicaid and commercial medical insurance billing, and d the technical aspects of revenue cycle management
  • Experience and knowledge of commercial and governmental insurance payer and clearinghouse portals, including billing guidelines and policy updates
  • 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

PREFERRED KNOWLEDGE AND SKILLS:

  • 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

REQUIRED CERTIFICATES/LICENSES/REGISTRATIONS:

  • Must be at least twenty-one (21) years of age

SUPERVISORY RESPONSIBILITIES:

  • N/A

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Job performed at a desk in front of a computer
  • Requires heavy use of mouse and keyboard
  • Indoor office environment
  • Though this position is not permanently located in a treatment facility setting, exposure to emotionally impaired patients is possible, and may be frequent. Stress ranges from low to high, depending on the situation

CONDITIONS OF EMPLOYMENT:

  • Completion of a tuberculin screening during first week of employment
  • Completion of a pre-employment drug screening, post-accident and upon reasonable suspicion of use
  • Completion of orientation and required paperwork prior to reporting to work
  • Demonstrated computer literacy
  • Attendance at all mandatory staff development and training
  • Completion of background and professional reference checks

Job Type: Full-Time

Compensation:

  • $24.00 - $28.00 per hour

Full-Time Benefits Include:

  • 85% Employer Paid Medical premium for employee level coverage – spouse and dependent premiums are subsidized at 50%
  • 100% Employer Paid Basic Life Insurance equal to 1x annual salary
  • 100% Employer Paid Employee Assistance Program
  • Voluntary Dental, Vision, Short-Term Disability, and Supplemental Life & AD&D Insurance
  • Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses
  • Generous Paid Time Off plan and 10 paid holidays annually
  • Employee Referral Bonuses
  • 401K Retirement Plan & Employer Match
  • Free counseling services and resources for emotional, physical and financial wellbeing
  • Consumer discounts through LifeMart
  • Free parking

Ability to Commute/Relocate:

  • Meridian, Idaho; reliably commute or plan to relocate before starting work (Required)

This job description is not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with this job. It is meant to be an accurate reflection of the principal job elements essential for making fair pay decisions about jobs.

Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.

Northpoint is an Equal Opportunity Employer. Northpoint is an at-will employer. Employment may be terminated at any time by employee, or employer with or without notice.