Patient Benefit Advisor - Doral

Patient Benefit Advisor

The University of Miami Health System has opened the second phase to our state-of-the-art facility in Downtown Doral that serves as a western hub for our distinguished regional network of ambulatory services. This 160,000 square foot expansion will continue to bring world-class academic medicine, cutting-edge technology, and innovative treatment options to the rapidly growing Doral community. UHealth at Doral will have services through the Sylvester Comprehensive Cancer Center, Bascom Palmer Eye Institute, and the Desai Sethi Urology Institute, as well as specialties such as cardiology, endocrinology, otolaryngology, gastroenterology, dermatology, and more. The expansion will provide residents with innovative, specialized medical services in the heart of their community. UHealth at Doral has 8 operating rooms, 3 endoscopy procedure rooms, 33 cancer treatment bays, over 60 multidisciplinary exam rooms, and supporting ancillary services like imaging, lab, and respiratory therapy.

Core Job Summary:

The Patient Benefits Advisor 2 ensures that patients have adequate insurance coverage for services received and advises patients when there are any gaps in coverage so that appropriate payment arrangements can be made.

Core Job Functions:

• Greets every individual on the phone or in person with a smile and a warm, professional greeting.
• Coordinates with appropriate scheduling department to schedule patient appointments when prior authorizations have not been obtained or have been denied.
• Assists departments with inquiries into the status of accounts, pre-certification, eligibility, financial estimates and department policies and procedures.
• Ensures all patient information is secure, and all paperwork disposed of appropriately to preserve confidentiality.
• Ensures that prior authorizations are obtained and fully documented prior to the receipt of services.
• Contacts physician offices to obtain missing patient information.
• Utilizes patient estimate tools and insurance company contacts to obtain accurate out-of-pocket estimates, documents these estimates, and generates estimate letters.
• Updates patient accounts as necessary with correct insurance information.
• Submits insurance referral documentation in a timely fashion.
• Adheres to University and unit-level policies and procedures and safeguards University assets.

Department Specific Functions:

• Reviews schedules and identifies patients who are uninsured/under-insured and/or have previous balances.
• Conducts comprehensive review of scheduled services, insurance coverages, previous balances, and payment history and creates a detailed estimate.
• Develops global packages for self-pay patients/guarantors promptly within 24 business hours of request.
• Serves as a patient benefit and financial advisor advocate by making outbound calls and/or meeting with patients and/or guarantors in order to educate and facilitate their understanding of the costs associated with the health care services they need, how much their insurance covers and what will be their out-of-pocket costs and provides them with a detailed estimate of costs.
• Assists patient/guarantors in meeting their financial obligations by offering payment plans and/or identifying alternate payment sources prior to date of service.
• Processes credit card payments made over the telephone in accordance with Payment Card Industry (PCI) security standards and monitors and follows up on pending deposits/payments.
• Establishes and maintains effective collaborative working relationships with other departments, providers, insurance companies, federal, state, or local agencies to assist patient/guarantor in meeting financial obligations.
• Provides statements in accordance with established policies and procedures.
• Strives to meet or exceed established individual and departmental key performance indicator goals.
• All collection efforts are clearly documented in the system and provide follow-up of accounts until they are resolved.
• Acts as a liaison and collaborates with the On-site Pt. Access Team, CBO, and Clinical Departments in resolving any charge or previous outstanding balance discrepancies.
• Trains new recruits in the Patient Benefit Advising team regarding procedures and systems and is the Subject Expert Matter and a resource to co-workers and internal customers.
• Performs other duties as assigned.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

Core Qualifications:

High School diploma or equivalent

Minimum three (3) years of relevant experience

Knowledge, Skills, and Attitudes:

• Strong customer service skills
• Strong written and verbal communication skills
• Highly detail oriented and organized
• Excellent interpersonal skills
• Knowledge of medical terminology

Any relevant education, certifications and/or work experience may be considered.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status:

Full time

Employee Type:

Staff