The Cost Estimate Specialist is responsible for collecting necessary insurance benefit and clinical information to authorize services or provide an accurate cost estimate for services based on the patient’s insurance benefits. This is a remote position that does require onsite attendance quarterly or as needed for training purposes.
The Cost Estimate Specialist determines the cost for the service by applying the patient benefits / coverage information and estimate functionality accessible through IT applications. This process is essential to ensuring the patient understands their financial responsibilities for the service rendered. This is a very dynamic environment as insurance plans, benefits, and coverage structures change frequently and the turnaround is essential so that treatment is not delayed.
This individual will need expert knowledge of insurance plans, insurance regulations, and insurance benefit and coverages as they relate to the service rendered. Additionally, this team serves as a point of contact within the organizations for questions and issues as they relate to insurance plans and coverage information.
The duties and responsibilities this individual performs is solely dependent on the organization receiving reimbursement for the service rendered and ensuring the patients cost are clearly identified.
Cost Estimates
- Utilizes online systems, phone communication and other resources to verify eligibility and create a cost estimate for scheduled services based on patient benefits.
- Communicates liabilities directly to patients and provides education on key insurance terms and rules; may often handle patients with more complicated insurance plans (e.g., workers’ comp)
- Documents the cost estimate in the EHR so that it can be collected prior to or on the date of service by Patient Access Coordinators and front desk staff.
- Demonstrates understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients’ out-of-pocket liabilities.
- Connects patients with financial counselors when further explanation or education is needed or requested regarding payment plans or financial assistance; may conduct some basic financial counseling duties as necessary.
- Notifies physician offices when patients are scheduled that have out of network or limited benefit plans.
Communication
- Communicates with patients, physicians, clinicians, front-end staff, or translators to obtain missing patient demographic or insurance information
- Communicates liabilities directly to patients and provides education on key insurance terms and rules; may often handle patients with more complicated insurance plans (e.g., workers’ compensation)
- Maintains excellent relationships with physician’s offices, insurance companies and other hospital departments.
Education
- Remains updated on payor requirements and rates and changes to pricing for estimates.
KNOWLEDGE AND SKILLS:
EDUCATION: High School Diploma or GED required. Associate or bachelor’s degree in healthcare administration or related preferred.
YEARS OF EXPERIENCE: One to two years of registration or insurance verification related experience required.
REQUIRED SKILLS AND KNOWLEDGE:
Excellent analytical skills required
Customer service experience required
General knowledge of the following:
EHR programs (e.g., Epic)
Medical terminology
CD-10, CPT, HCPCS codes, and coding processes
Knowledge of or experience with other front-end processes, including scheduling, pre-registration, financial counseling, and registration; understanding of the revenue cycle as a whole
Superb teamwork skills
Efficient time management skills and ability to multitask
Excellent writing, oral, and interpersonal communication skills
Strong understanding and comfort level with computer systems and payor regulations
LICENSES REGISTRATIONS &/or CERTIFICATIONS:
Annual Registration Competency Test at 95%
Stat Test
For more than 130 years, The Christ Hospital been the beacon for exceptional healthcare in the Greater Cincinnati community. We're industry pioneers, always pushing the boundaries and reimagining the future of healthcare.
Our culture promotes collaboration, diversity and innovation. Together, as a team, we work tirelessly to enhance healthcare quality, accessibility and safety.
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