Financial Eligibility Specialist

2 weeks ago

Fairfield, California, United States NorthBay Health Full time
Job Overview

At NorthBay Health, the Financial Verification Ambassador plays a crucial role in ensuring the accurate and timely pre-registration and financial assessment for both scheduled and unscheduled patient admissions, outpatient procedures, and ambulatory services. This includes managing appointment scheduling, verifying patient eligibility, benefits, and coverage limitations, as well as collecting necessary payments or arranging financial plans for patients to meet their deductible and co-payment obligations.

Key Responsibilities

The Ambassador is responsible for:

  1. Obtaining all required authorizations and collaborating with case management to fulfill reporting and utilization review requirements, ensuring optimal reimbursement.
  2. Engaging in informative discussions with patients regarding their coverage eligibility and benefits, which encompasses coordination of benefits, authorization statuses, estimated charges, outstanding deductibles, co-pays, and previous balances.
  3. Proactively addressing patient concerns and referring them to appropriate members of the Patient Access or Financial Counseling teams when necessary.
  4. Exhibiting professionalism and empathy through courteous interactions, maintaining confidentiality, and presenting oneself appropriately.
  5. Assisting the QA/Training Coordinator and Exceptional Experience Coaches with training initiatives and quality improvement projects within the department.
  6. Consistently achieving or surpassing departmental goals related to productivity, financial stewardship, and patient satisfaction metrics.

Department Mission Statement

Our mission is to create a memorable and inspiring experience for every customer we serve. We differentiate ourselves through our ability to listen and empathize, making extraordinary efforts to deliver exceptional service. We guide our customers—patients and their families—through a seamless healthcare journey, providing tailored assistance and education that meets their unique needs and expectations. Our commitment is to foster lasting relationships with our patients through positive experiences and accountability in every interaction.

Qualifications

  1. Education: An Associate Degree is preferred.
  2. Certification: Relevant certification in Patient Access and/or Revenue Cycle from a recognized healthcare credentialing organization is required within 12 months of hire.
  3. Experience:
    1. A minimum of five years of customer engagement experience in a healthcare revenue cycle setting is required.
    2. Strong oral and written communication skills, with the ability to articulate thoughts effectively. Extensive experience with insurance health plans and knowledge of billing regulations is essential, along with a preference for phone-based customer service experience.
    3. Expertise in differentiating between various insurance types, including Medi-Cal, Medicare, Managed Care, Indemnity, and Workers Compensation, along with understanding eligibility requirements and benefit coordination.
    4. Understanding the impact of accurate registration and admission processes on successful claims processing and patient care delivery.
    5. Performance Standards: Adherence to established policies and procedures, demonstrating punctuality and attendance.
    6. Physical Requirements: Attendance is a critical function of this role, with reasonable accommodations available for individuals with disabilities. The position may involve slight to moderate physical exertion.
    7. Interpersonal Skills: Embodying the NorthBay Way, which includes values of Caring, Communication, Collaboration, and Competence. A commitment to service excellence, professionalism, compassion, and strong listening skills is essential. The ability to demonstrate empathy, optimism, resourcefulness, and cultural competency in interactions is required, along with advanced critical thinking skills to navigate complex patient financial scenarios.
Compensation:

Hourly Pay Range MIN: $35.36 (Offered hourly rate based on years of experience in a similar role).

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