What are the responsibilities and job description for the Benefit advisor position at Spectrum Health?

Job Summary

Under general direction of the Patient Access Mangaer - 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 3rd 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 Functions

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.
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, 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 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.

Qualifications

Required High School Diploma or equivalent
Required Associate's Degree or equivalent or four (4) years of equivalent experience in business or related field.
2 years of relevant experience 2-3 years’ experience working with government entitlement programs (, Medicaid) in a previous financial counseling or third-party billing role. Preferred
Previous Medicaid application processing experience highly desirable. Preferred
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. Required

Physical Demands

Pallet to Waist (6" from floor) >