Patient Resource Specialist

Job Description

REQUIREMENTS

• High school graduate or equivalent required.
• 2 years of related prior work experience required, preferably in an infusion company. Applicable experience should include work with medical health insurance, medical billing, HIPAA, Medicare, medical abbreviations, and terminology.
• 1 year of experience working in a customer service position is required, preferably experience working directly with patients.
• Must possess outstanding communication and interpersonal skills, communicate professionally and effectively with other staff members, patients, vendors and physicians, and is fluent in written and spoken English.
• Proficient with all Microsoft Office Products (Office, Excel, PowerPoint, Teams, Outlook, etc.)

RESPONSIBILITIES

• Educate and inform patients about insurance benefits and financial responsibilities.
• Ensure patients are evaluated, educated and enrolled in medication/administration assistance programs, external and internal financial programs
• Manage a case load of patients in an assigned territory, build a relationship with patients, answer questions and act as an advocate for patient needs around insurance and financial management of healthcare expenses
• Ensure access to the best financial resources available for patients with consideration of company revenue
• Input all documentation of conversations with patients and insurance carriers into EMR
• Effectively convey written and verbal information to patients, patient families, supervisors, insurance contacts, and Clinical Operations (COPs) staff
• Interface with the (ROPs) department on insurance eligibility and benefits
• Communicate and maintain contact with ROPs and management regarding patient’s accounts, which include subjects such as: COB issues, EOBs, APPs, authorizations/referrals to discuss patient responsibility portions
• Communicate with the ROPs and COPs regarding patient concerns, providing solutions to patient’s issues or following up on additional assistance needed from leadership
• Investigate any insurance issue concerning loss of coverage and determine a course of action (i.e. Appeals, Dept. of Labor, and Dept. of Insurance)
• Review EOBs and account notes to assess and advise on patient responsibility
• Recommend various insurance options such as Cobra, EGHP, Medicare, and other insurances to analyze and determine a course of action, during open enrollment and as applicable
• Assist patients with balances and work with them to resolve financial concerns before escalation to the collection process.

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