Patient Resource Specialist

Patient Resource Specialist

Business Services Department

1.0 FTE, 80 Hours a Pay Period

Days, Hours between 7:30 am

• 4:00 pm

Weekends: No

Holidays: No

Telecommute Available: No

Position Overview:

As the Patient Resource Specialist, you will be responsible for working closely with our patients and the Winona Health care team to ensure patients are informed of their insurance coverage or lack of coverage. Duties include speaking directly with both patients and insurance companies either in-person, over the phone, or electronically regarding insurance benefits and billing location (inpatient, outpatient, provider based).

Essential Duties & Responsibilities:

• Gathers and/or verifies patient information including insurance coverage and confirms patient eligibility.

• Advocates on behalf of patients to ensure maximum benefit available under patients' health plan.

• Screens patients for HPE (hospital presumptive eligibility) or connects patients to appropriate resources for patients to obtain coverage.

• Maintain accurate and detailed records of patient and insurance interactions which provide clear information on status of patient inquiries/potential services. Researches account discrepancies in order to explain and educate patient on account balances.

• Educates, counsels, and helps patients apply for Winona Health Financial Assistance program either in-person, by phone, or electronically through secure messaging.

• Will be assigned one or more of the following duties:

• Financial Assistance

• Send approvals, denials, and missing information letters. Apply financial assistance adjustments to accurately reflect appropriate discount on patient's account.

• Eligibility and Benefits with Price Estimations - works with pricing software to inform patient of insurance benefits, insurance coverage, and price of services. Coordinates with patients to sign any notice of non-coverage/advance beneficiary notice and collects any balances due at time of service for any non-covered charges.

• First/Third Party Collections - works with first/third party collection agencies to review, sign attestations, and complete turnovers. Is the liaison with the agencies and Winona Health management to coordinate court dates and settlement offers/agreements.

• Approve Statements - work with statement vendor to ensure daily statement files are received. Will approve or deny statements based on department guidelines. Screens and applies uninsured discount per department policy.

• Review and prepare any legal documents for judgements, patient bankruptcy notices, and worker's compensation interventions.

• In addition to the responsibilities described above, the role may include other duties and responsibilities as assigned, based upon Winona Health's needs or requirements.

Supervisory Responsibilities:

No direct reports

Skills and Experience:

Required:

• Associates Degree or equivalent experience in a billing related field

• Must become HPE certified within 30 days of hire

• Attention to detail and ability to multi-task

• Advanced time-management and organizational skills to handle multiple priorities with shifting timeframes

• Basic computer skills: Microsoft Word, Outlook, & Excel

• Discretion and good judgement in responding to questions by patients, providers, and other professional personnel

• Must possess effective customer service oriented communication skills

Preferred:

• Previous billing and/or collection experience is preferred but not required

• Bilingual in English and Spanish is preferred but not required

Internal Applicant Policy:

It is the policy of Winona Health to work with employees in an equitable fashion regarding promotions, transfers, and position reclassifications.

Any employee wishing to apply for another available position at Winona Health must submit an application for consideration through the internal application portal. Employees requesting to change positions should have successfully completed at least six (6) months in their current position. Employees currently in the formal disciplinary process may be required to meet with the Director of Human Resources to determine eligibility to request transfer. The employee's past performance, experience, training and qualifications will be considered in transfer/hiring decisions. Consideration for transfer or promotion is not a guarantee of transfer or promotion. Employees may be given a chance to interview for a position when they meet the minimum position qualifications.

Disclaimer:

Winona Health is an equal opportunity employer. Winona Health does not refuse to hire, discharge, or discriminate against a person with respect to tenure, compensation, terms, upgrading, conditions, facilities, or privileges of employment because of race, color, creed, religion, sex, age, national origin, marital status, genetic information, status with regard to public assistance, membership in a local discrimination commission, sexual orientation, disability, veteran status, or any other prohibited basis of discrimination under applicable local, state, or federal law. Winona Health does not tolerate retaliation against any employee, patient/resident, physician, or other individuals pursuing concerns regarding Civil Rights issues. Winona Health adheres to ALL pertinent governmental policies and legislation including the Civil Rights Act of 1964, Title VII, as amended, and the Minnesota Human Rights Act.