Eligibility and Benefits Representative | AFC Urgent Care | Portland

Department: Billing

Reports to: Billing Manager

Supervises: Not Applicable

Employment Status: Full time, Non-Exempt, Hourly 

Summary: The EBR Lead is responsible for coordinating the day-to-day workflow of the Eligibility & Benefits Representatives team.   The EBR also serves as a liaison for other AFC departments and staff.  The EBR team regularly working scheduled shifts verifying eligibility and benefits. This position requires evening and weekend hours. 

Essential Duties and Responsibilities: 

  • Eligibility & Benefits Verification
  1. Regularly monitors insurance verification folders for verification requests from the clinic staff
  2. Verifies and enters insurance and guarantor information, and promptly notifies clinic staff of results
  3. Checks patient’s billing account for balances and notes
  4. Reviews patient benefits and advises staff whether the patient is a candidate for HRSA program
  5. Completes the eligibility verification process promptly and timely to provide clinic staff and patients with accurate coverage and patient responsibility information prior to the start of an office visit
  6. As needed, directly answers patient questions in regards to the verification status
  7. Answers incoming telephone calls when needed
  8. Assists with billing office requests
  9. Assists with clinical staff requests
  10. Uphold HIPAA laws and guidelines while performing all duties without exception
  • Regular and consistent attendance is an essential function of this job;
  • Report to work as scheduled, on time, and dressed appropriately;
  • Work with all billing staff members and clinic staff to promote teamwork and help ensure a productive and positive work environment;

Additional Duties: 

  • Billing Department Support
  1. Backup billing staff by answering patient billing questions in a timely professional manner as needed
  2. Check patient’s billing account for balances and notes
  3. Update financial messages left in patient accounts for all discussions 
  • Other duties as reasonably requested
  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Qualifications:

    • Commitment to AFC Urgent Care’s mission to be CHECT: Commitment, Health Excellence, Celebrate & Trust
    • Commitment to reflect AFC Urgent Care Core Values: We value each individual and commit to improving every life we touch with dignity, care, and compassion. 
    • Commitment to maintaining confidentiality

    Experience: 

    • Minimum one year of experience working in a medical office or health care setting required
    • Minimum one year of experience working with health insurance plans required
    • Supervisory experience preferred
    • Experience in medical billing preferred
    • Experience working with an EMR preferred

    Knowledge:

    • Basic knowledge of health insurance and medical coverages required
    • Basic knowledge of medical billing preferred

    Skills and Abilities:

    • Excellent customer service skills
    • Excellent data entry and organization skills
    • Ability to multitask while paying attention to detail
    • Demonstrated ability to work independently and efficiently to accomplish required tasks and duties with minimal supervision
    • Ability to work at a rapid pace, being involved in several duties at one time

    Language Skills:

    • Excellent verbal and written communication skills
    • Ability to communicate effectively with team members
    • Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
    • Ability to communicate professionally and effectively with patients and representatives of health insurance organizations, specifically demonstrating professional phone etiquette  

    Reasoning Ability:

    • Ability to resolve practical problems 
    • Ability to interpret a variety of instructions furnished in written, oral, diagram and schedule form
    • Ability to give and follow written and verbal instructions in a safe and appropriate manner

    Mathematical Skills:

    • Knowledge of basic mathematical computations and equations, and the ability to add, subtract, multiply, divide and calculate figures 

    Computer Skills:

    • Proficient in operation and use of PC 
    • Proficient in all Microsoft Office products and web-based applications
    • Proficient in EMR, proficiency in Docutap preferred

    Physical Demands:

    • Regularly required to talk or hear at normal levels
    • Regularly required to stand, walk, sit, use hands to handle or feel, reach with arms and hands 
    • Occasionally required to stoop, kneel, crouch, or crawl
    • Regularly requires lifting, bending, reaching, pushing, carrying
    • Regularly requires lifting and/or moving up to 25 pounds
    • Vision corrected to normal range and occasionally requires close vision and ability to adjust focus 

    Working Environment:

    • Comfortable, indoor office environment.  Will require evening and weekend work.
    • Noise level is usually moderate
    • Rare travel required between clinic sites
    • Tasks create exposure to hazardous conditions including potential exposure to infectious diseases and potential close contact with individuals who are ill; potential exposure to bloodborne pathogens such as blood, bodily fluids, and/or tissue; potential exposure to hazardous chemicals; potential exposure to physical violence  
    • Machines, equipment, tools, supplies used: computer, fax, copier, calculator, multi-phone system, scanner
    • Duties can be expected to be performed concurrently. Must be able to work under conditions of constant interruption and be able to concentrate and stay on task. 
    • Patient Health Information Portability and Accountability Act (HIPAA) access requirements include treatment, payment, and operations.