As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
Greets patients and families in person or by phone using AIDET. Maintains a friendly and welcoming atmosphere in a busy and public work environment. Maintains patient confidentiality.
Collects and documents accurate patient demographics and insurance information.
Analyzes insurance coverage and benefits for service to ensure timely reimbursement.
Obtains all prior authorizations as appropriate based on insurance plan contracts / guidelines and documents in EPIC system per policy and procedure.
Enters and updates referrals as required.
Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and benefits.
Notifies families of insurance limitations or potential out of pocket costs for requested services.
Facilitates referral to Financial Services for payment sources for uninsured patients.
Schedules and assists with coordinating appointments for multiple disciplines and with outside vendors as appropriate by program.
Requests picture ID 100% of the time during initial check-in of evaluation
Systematically collects consents and other required documents (real-time)
Verify insurance cards and other important documents (real-time)
Collects and posts co-pays, any past due balances, and reconciles money at the end of the shift, as required by program
Schedules follow-up appointments as needed
Achieve a daily “after visit” verification (insurance and demographics) percentage of => 95%
Alerts clinical staff of patient arrival and communicates with clinical staff as to the status of patients waiting more than 10 minutes after scheduled visit.
Works collaboratively with clinical staff, Central Business Office, financial counselors etc to assure coverage and payment are obtained for all services rendered.
Identifies trends and alerts managers and supervisors to plan benefit changes that may affect services.
Appropriately communicates with a variety of contacts (patients, parents, physician, clinicians, patient relations, translators etc).
Must have ability to work well with others.
Regular attendance required.
Good communication skills are required both written and verbal.
Verify insurance benefits for Durable Medical Equipment (DME), update teamshare with appropriate DME information, notify clinical staff of any issues with DME benefit, and inform families of any (OOP) out of pocket expenses.
Must be a graduate of high school required, college degree preferred
Excellent customer service skills in a fast paced changing environment.
This position provides a high customer service to our patients, payors and physicians by phone
EPIC experience preferred
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is a pediatric health system of hospitals and specialty clinics serving children and families throughout the Delaware Valley and Florida. Our dedicated professionals integrate medical care, research, health education, and prevention to help improve the lives of children every day.