Specialist Elig Assistance (Full-Time w/Benefits; Days) at Nicklaus Children's Health System in Miami, Florida

Job Description:

Job Summary:
Responsible for obtaining accurate and complete information from patients, families, and applicable third party sources as necessary to determine financial eligibility, assist patients with any and all avenues of financial assistance available to them, and submit subsequent applications to governmental assistance programs.
 
Minimum Job Requirements:

Two years of experience in a healthcare medical/clinical office or patient eligibility services experience

Job Specific Duties:

• Interviews inpatient and ED patients/families to obtain demographic, third party payer, and other financial information.


• Explains insurance benefits to inpatient and ED patient/family, notifies them of any deductible, co-payments, or deposits required at point of service.


• Collects payments, financially clears patients, and when required, assists in completing Medicaid applications at bedside.


• Explains insurance benefits to patient/family prior to their scheduled day of service, collects payment, and financially clears patient/family via phone.


• Completes Medicaid applications at bedside, and collects all necessary documents in order to submit application in a timely matter.


• Submits Medicaid applications online, hand delivers application and all required documents to the in-house Department of Children and Family representative and ensures timely completion.


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  Follows up with in-house Department of Children and Family representative to ensure Medicaid applications are processed, and to verify, clarify, and confirm Medicaid eligibility.


• Notifies Utilization Review, Social Services, and Patient Access of case screening determinations and outcomes via verbal and written communication.


• Records, and maintains complete documentation of all activities performed in the Collection Notes file of the computer system.


• Scans all documents in the appropriate folder in the computer system.


• Verifies third party payer information as required via the web or telephone.


• Assists patients with financial and governmental assistance applications such as Kid Care, and offers customers 24/7 assistance via phone, walk-in, or tele-conference. F: daily/T: 45 minutes per patient/R: Individual


• Completes financial evaluation forms, and refers zero balance accounts that are ineligible for any assistance program to Patient Financial Services for charity determination.


• Reviews daily logs, and follows up on accounts that were missed within 24 hours.


• Completes financial responsibility forms on self-pay patients.


• Counsels all NCH urgent care centers on patients’ financial eligibility.


• Pre-screens patients, and completes, and submits Medicaid, Kid Care, or financial evaluation applications for self-pay urgent care centers accounts.


• Reviews all self-pay urgent care accounts post services to ensure that all accounts are financially cleared, and if appropriate, collects payment over the phone.


• Financially assesses international unfunded ED patients, screens for Medicaid eligibility, advises appropriate parties of case and its financial outcome, and clears when appropriate.


• Participates in community outreach to reduce the uninsured children population in South Florida. F


• Completes Trac-Fone applications for eligible Medicaid patients, provides phones to families, and trains them on how to use Trac-Fone.


• Answers patient/family billing related questions/concerns, and collects payment on rendered medical services on behalf of Patient Financial Services.


• Acts as a liaison with other departments of the hospital, physician offices, and urgent care centers. 

• Maintains accountability by ensuring compliance thru timely completion of licensures, certifications, all competencies, health requirements (PPD, N95, Flu, etc.), and education requirements.


• Maintains accountability and timekeeping expectations as outlined by MCHS Timekeeping and Attendance policy & procedures.  Ensures behavior is compliant with communication standards. 


• Ensures behavior meets and/or exceeds targeted service scores as measured by the Service Index and/or the internal departmental service survey.

• High school education or equivalent preferred


• One year of experience working with medical terminology, procedures, diagnosis codes and insurance strongly preferred


• Knowledge of rules and regulations pertaining to Federal, State, and County medical assistance programs.


• Able to communicate effectively in English both verbally and in writing in a clear and concise manner


• Fluent in Spanish strongly preferred


• Basic proficiency in Word, Excel and Outlook


• Able to multitask and work in a fast paced environment


• Able to adapt and react calmly under stressful conditions


• Able to relate cooperatively and constructively with customers and co-workers


• Able to follow complex written and/or verbal instructions to solve problems such as preparing documentation to submit to governmental assistance agencies, and providing appropriate status on active cases


• Able to establish necessary professional relationships, and interact effectively with internal and external customers

(EOE DFW)  

Updated 4/11/17