Test Lead managing end - to - end testing for large implementations in Pharmacy Benefit Management. Collaborating with business and IT stakeholders for readiness and process support.
About the role
- Public Benefit Specialist assessing uninsured/under-insured patients for state Medicaid benefits at Ensemble, providing support to ensure timely application processes. Collaborating with healthcare partners and maintaining updated patient information in systems.
Responsibilities
- Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or Financial Assistance program.
- Assists with application processes to facilitate accurate and appropriate submissions.
- Follows-up on submitted applications to ensure timely billing or adjustment processing.
- Reviewing all referred uninsured/under-insured patients for program eligibility opportunities.
- Effectively communicating with the patient to obtain documents that must accompany the application.
- Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
- Documenting all relevant actions and communication steps in assigned patient accounting systems.
- Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
- Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners.
Requirements
- 1-2 years of experience in healthcare industry, interacting with patients regarding hospital financial issues.
- Bilingual speaking proficiency in Spanish/English
- High School Diploma or GED.
- Understanding of Revenue Cycle including admission, billing, payments and denials.
- Comprehensive knowledge of patient insurance process for obtaining authorizations and benefits verification.
- Knowledge of Health Insurance requirements.
- Knowledge of medical terminology or CPT or procedure codes.
- Patient Access experience with managed care/insurance and Call Center experience highly preferred.
Benefits
- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits
- Career Advancement
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