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As a Health Benefits Specialist I, you will be responsible for ensuring a positive and seamless experience for patients and visitors within PHC medical or dental clinics. You will conduct financial screenings, assist with insurance enrollment (including Medicaid and Marketplace plans) and financial assistance programs, address billing questions, perform back-billing, monitor the payer mix, and support compliance. This role involves patient outreach, in-person support, and maintaining accurate documentation for financial assistance and billing. You will collaborate with billing and clinic staff to ensure timely and effective patient support. You will also provide support and coverage for the Patient Access Representatives.

What You Will Do

+ Ensures a consistent revenue cycle process in medical and/or dental clinics by reviewing patient schedules to identify patients with upcoming appointments who need assessment for financial assistance, other available benefits, or payment plans.

+ Completes phone outreach to patients with past balances, expired insurance plans, needed documents for income verification or uninsured to screen and determine appropriate next steps for patients.

+ Meets with patients as needed to help them apply for Medicaid (including Hawk-I), Marketplace coverage, or other insurance programs. Conducts outreach and enrollment activities including annual Marketplace enrollment events. May provide assistance at various locations, including PHC clinics, community agencies.

+ Helps patients apply for the sliding fee program.

+ Maintains patient financial assistance files including electronic notes in registration and/or financial note files.

+ Completes necessary back-billing for applicable patients when insurance is identified or approved after the visit.

+ Answers patients’ questions related to billing statements and collaborates with the billing department to support patients in resolving issues related to medical and/or dental bills.

+ Verifies and follows-up on patient credits and/or refunds that are identified through patient question or account verification processes.

+ Completes monthly laboratory and radiology billing.

+ Communicates with patients about anticipated cost of visit, if applicable. Creates and distributes good faith estimate letters in accordance with the No Surprises Act and upon patient request.

+ Monitors and reports on payer mix for their assigned clinic and works with Clinic Director to address unfavourable payer mix changes.

+ Provides ongoing support and coverage to the Patient Access Representative role.

+ Performs other duties as assigned.

Qualifications You Need

Required

+ High school diploma or equivalent.

+ Two years of experience in healthcare, human services, or social services; or three years in customer service.

+ Effective verbal and written English communication skills.

+ Effective verbal and written Spanish communication skills.

+ Professionalism and excellent customer service skills.

+ Detail oriented with a high degree of accuracy.

+ Problem-solving and critical thinking skills.

+ Takes initiative and is dependable.

+ Team oriented with the ability to work collaboratively.

+ Basic math skills.

+ Ability to understand and follow written instructions.

+ Proficiency using Microsoft Office and Google Suite computer applications.

+ Ability to learn and effectively use the electronic health record system.

+ Organization, prioritization, and time management skills.

+ Strong interpersonal skills with ability to establish and maintain effective working relationships with a

+ diverse group of individuals.

+ Completion of Presumptive Eligibility training and training completion award documentation are required within the introductory period of the position and must be maintained throughout employment thereafter.

+ Licenses & Certifications: Certified Application Counselor (CAC) certification is required within 12 months of starting in position.

Preferred

+ Higher education degree in a related field.

+ Senior Health Insurance Information Program (SHIIP) Counselor Certification.

+ Work experience in a community health center, medical or dental clinic, or in the essential functions of the position.

+ Knowledge of clinical terminology.

+ Knowledge of health insurance eligibility requirements, enrollment processes, and insurance impacts on the revenue cycle.

We Take Care of Our People

Your related experience and skills determine your base pay. Our typical hiring range for this position is $17.00 - 21.25 per hour. Candidates with extensive related experience may be considered for additional compensation up to the pay range maximum. In addition to base pay, PHC offers a comprehensive benefits package, including:

+ Generous PTO accrual

+ Eight paid holidays

+ License/certification fee reimbursement*

+ Paid time off for continuing education & continuing education reimbursement*

+ Tuition reimbursement program

+ 401k with company match

+ Medical insurance

+ Dental insurance

+ Vision insurance

+ Life & disability insurance

+ Flexible spending & health savings accounts

+ Supplemental accident & critical illness insurance

+ Discounted pet insurance

+ PHC Pride rewards program

Visit https://phciowa.org/careers for a summary of PHC’s benefits.

*Applies to positions requiring clinical licensure or certification.

Grow Your Career with PHC

We take pride in offering development and growth opportunities to our team. Some of our training opportunities include Emerging Leaders, Dental Assitant Trainee Program, & Medical Assistant Trainee Program. In the last year, over 30% of our open positions were filled through promotions or transfers.

Join the PHC Community

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