This opportunity is part of the NEW Med Center Health Contact Center. Med Center Health is launching a centralized Contact Center that will serve as a single point of contact for patient scheduling, insurance authorization, and financial clearance services. This innovative approach will simplify the patient journey, improve access to care, and enhance the overall patient experience.
Position Summary
The Patient Estimate Specialist is responsible for preparing and communicating patient estimates of anticipated financial responsibility for healthcare services. This position reviews insurance eligibility, benefits, payer information, service details, and applicable organizational guidelines to calculate estimated patient liability. The Patient Estimate Specialist educates patients regarding estimated out-of-pocket costs, payment options, financial assistance resources, and financial clearance processes. This position also supports compliance with price transparency and No Surprises Act requirements, including Good Faith Estimate processes for uninsured or self-pay patients, while promoting informed financial decision-making and a positive patient experience.
Minimum Qualifications
- Experience in healthcare revenue cycle, patient access, insurance verification, financial counseling, customer service, or a related field preferred.
- Knowledge of healthcare insurance plans, benefits, and patient financial responsibility concepts preferred.
- Knowledge of medical billing and reimbursement processes preferred.
- Strong customer service and communication skills.
- Ability to explain financial information in a clear and professional manner.
- Strong analytical and problem-solving skills.
- Strong organizational skills and attention to detail.
- Proficiency with computer systems and standard office software applications.
- Experience with Epic or similar healthcare information systems preferred.
Key Responsibilities
- Reviews insurance coverage, eligibility, benefits, payer requirements, and scheduled service information to determine estimated patient financial responsibility.
- Prepares and communicates patient estimates for scheduled healthcare services in accordance with organizational procedures.
- Supports Good Faith Estimate processes for uninsured or self-pay patients in accordance with No Surprises Act requirements and organizational guidelines.
- Educates patients regarding estimated out-of-pocket costs, deductibles, coinsurance, copayments, non-covered services, and other potential financial obligations.
- Discusses available payment options, financial assistance resources, and related financial clearance processes with patients.
- Documents estimate activity, Good Faith Estimate information, patient communications, and related follow-up within designated systems.
- Collaborates with scheduling, authorization, registration, clinical, and revenue cycle teams to support accurate estimates and timely financial clearance.
- Responds to patient inquiries regarding estimates, insurance coverage, Good Faith Estimates, and payment-related concerns.
- Identifies and communicates discrepancies, missing information, or potential barriers that may affect estimate accuracy or financial clearance.
- Maintains current knowledge of payer requirements, reimbursement methodologies, price transparency expectations, No Surprises Act requirements, and organizational financial clearance practices.
- Assists with process improvement initiatives related to patient estimates, Good Faith Estimate workflows, financial transparency, and patient communication.
Ensures compliance with applicable regulatory, payer, and organizational requirements.
-
Location: Med Center Health · CHC Financial Clearance
Schedule: Full Time, Day Shift
