Job Description

Job Summary
The Health Benefit Specialist I is responsible for providing excellent customer service in a medical or dental clinic while delivering benefits education, outreach, and in-person assistance to patients to obtain and maintain health coverage and other benefits. Coordinates with PHC team members to provide positive service experiences for patients.

Essential Functions

• Ensures a consistent revenue cycle process in a medical or dental clinic:
  • Reviews patient schedules in medical or dental clinic scheduling systems to identify patients with upcoming appointments who need assessment for financial assistance, payer sources, other available benefits, or payment plans.
  • Performs insurance verification and confirms network coverage at patient’s request.
  • Maintains complete and accurate patient financial assistance files which includes electronic notes in registration/financial note files.
  • If applicable, reviews monthly laboratory and radiology billing to verify eligibility for PHC financial assistance program and communicates adjustments to appropriate vendors. Works in collaboration with PHC’s billing department to complete necessary back-billing for patients who gain access to entitlement programs and/or private insurance.
• Conducts outreach and enrollment activities related to medical or dental care:
  • Assists patients in completing the application process for appropriate benefits and programs. May provide assistance at various locations, including PHC clinics, community agencies, & in patients’ homes.
  • Acts as a patient advocate throughout the application and enrollment process.
  • Answers patients’ questions related to billing statements and collaborates with the billing department to support patients in resolving issues. Identify and support patients to address patient barriers and provide necessary patient education to ensure continuity of health coverage and other benefits.
• Monitors payer mix for assigned clinic and works with Clinic Administrator to address unfavorable payer mix changes.

Minimum Qualifications
Education: High school diploma or equivalent
Experience: One year in a healthcare environment or two years in a customer service role.
License/Certifications:

• Presumptive Eligibility Certification required within 4 months of starting in the position and must be maintained throughout employment thereafter.
• Certified Application Counselor (CAC) certification is required within 12 months of starting in position and must be maintained throughout employment thereafter.

Knowledge, Skills or Abilities:

• Excellent customer service skills
• Effective English communication skills, written and verbal
• Effective Spanish communication skills, written and verbal (Not required for community clinics)
• Ability to think critically to effectively resolve problems
• Initiative
• Dependable
• Able to provide own transportation to other clinics and off-site work locations as assigned
• Effective listening skills
• Contributes to a team approach to care
• Ability to follow written and verbal instructions
• Ability to perform arithmetic and calculate annual income
• Accurate and efficient typing skills
• Efficiently performs basic computer functions, internet navigation, and email
• Demonstrates attention to detail in work
• Prioritizes assigned work
• Establishes and maintains effective working relationships with a diverse group of individuals
• Interacts with others in an empathetic manner while maintaining professional boundaries
• Remains calm and works through difficult interactions

Other Job Requirements:

• Must be at least 18 years of age.