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Patient Insurance Benefit Specialist - Western Hematology & Oncology - Golden, CO

at National Jewish Health

Posted: 8/12/2020
Job Status: Full Time
Job Reference #: 13234
Keywords: insurance, claims

Job Description

National Jewish Health/National Jewish Health - Western Oncology/Western Hematology

Golden, CO

Full Time (40 hours per week)

Work Hours: 8:00 am - 5:00 pm

Req # 13234

Evaluates patient's potential financial liability prior to and after medical services have been rendered.  This includes working with patients and their families to evaluate financial data and determine ability to pay, negotiating payment arrangements and administering hospital and state financial assistance programs.


Essential Responsibilities



1.    Evaluates and communicates patient's potential financial liability directly to the patient  prior to medical  services being rendered based on  insurance verification data and medical cost estimates.    Negotiates collection deposits of estimated co-insurance, co-pay and deductible amounts.

2.    Provides financial counseling by telephone, electronic/standard mail or face-to-face to patients/guarantors to ensure collectability of patient balances and/or accounts in compliance with federal and state laws regarding debt collection and hospital billing and collection policies.  This includes securing patient payments by negotiating payment plans or arranging alternative settlement agreements. 

3.    Administers hospital financial assistance policies and the Colorado Indigent Care Program (CICP).  Audits and adjusts all charity accounts monthly.  Interprets individual, self-employed and business financial statements to accurately rate a patient using the guidelines of the charitable programs.

4.    Evaluates patient financial applications for Colorado Medicaid eligibility.  Assists patients with Colorado Medicaid application process.

5.    Maintains ability to read and comprehend all payors' claims adjudication vouchers. Utilizes vouchers in order to perform comprehensive account audits as necessary on self-pay balance disputes, processing of patient refunds, payment transfers and adjustments in accordance with PBO policy. 

6.    Handles all patient questions and concerns with regard to the processing of patient insurance claims and financial assistance eligibility.  Performs self-pay and bad debt collection follow-up as assigned and in accordance with PBO policy.

7.    Maintains a current and thorough working knowledge of third party payors processing in regards to medical management policy, provider contractual obligations, patient benefit levels, and payor specific insurance terminology.     

8.    Establishes and maintains effective working relationships and customer service skills. Including patients, clients, all co-workers, third party payors, NJH's EOVC and collection agency.   Actively participates in team and departmental meetings by sharing ideas for improved work processes in the PBO.

9.    Communicates regularly with Supervisor or Manager regarding high-risk accounts.  Identifies and refers problematic workflow trends to Supervisor for evaluation and solution. 

10.  Provides supervisor with weekly productivity statistics and reports workload fluctuations (backlog or shortages) in a timely manner. 

11.  Performs all other duties as assigned.


Knowledge and Skills

Knowledge and experience with third party payor billing regulations and reimbursement requirements. 

Experience in applying the Fair Debt Collection Act, Colorado Medicaid eligibility requirements and CICP.

Effective and diplomatic oral and written communication skills, including successful negotiation techniques,

handling difficult customers, demonstrated telephone skills.  Experience with PCs and common patient

accounting systems  as well as other electronic software applications.  Experience in planning, prioritizing and

organizing work in an environment with frequent interruptions.  Effective problem solving, analytical and multi

tasking skills.




Associate's degree is required.  Business-related degree is preferred.


Certification and Licensure



Work Experience

A minimum of two (2) years of recent and related experience in healthcare financial counseling required.  A minimum of one (1) year experience in accounts receivable collection experience in health care environment is required. 


- or - Any equivalent combination of Education and/or Experience  

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!