Insurance and Cost Estimate Representative
Apply for the Insurance and Cost Estimate Representative role at Albany Medical Center.
Department/Unit: Patient Access
Work Shift: Day (United States of America)
Salary Range: $41,136.28 - $57,590.79
Essential Duties and Responsibilities
- Review all self-pay encounters to identify insurance or determine referral to Enrollment Service Partner.
- Assess challenging encounters from out of state or international to secure payment source.
- Provide accurate estimates in support of the No Surprise Act, Good Faith Estimates guidelines, and Financial Aid Policy.
- Explain insurance benefits and self-pay estimates to patients, including collection of balances owed.
- Review, assess, and reconcile Medicaid Pending inventory to ensure timely disposition.
- Determine eligibility, benefits, and coverage to ensure 100% coverage for inpatient and outpatient services.
- Explain financial responsibility and associated policies and legislation to clinic staff, outside providers, and patients.
- Support department operations to ensure all encounters are financially secured prior to discharge.
- Work with Albany Med Health System colleagues to meet workload expectations as a team.
- Contribute to a compassionate and caring environment for patients, families, and colleagues.
Qualifications
- Associate’s Degree – required.
- Bachelor’s Degree – preferred.
- 3–5 years of experience with third-party payer regulations, healthcare financial counseling, and hospital or physician office experience; or 5–7 years experience in lieu of a degree.
- Exceptional knowledge of insurance discovery strategies, including payer portals.
- Knowledge of hospital financial law related to the No Surprise Act and Good Faith Estimate legislation.
- Demonstrated critical thinking skill for successful resolution of complex issues.
- Proven customer service skill with an ability to exceed expectations in sensitive patient interactions.
- Ability to analyze encounter history to secure financial responsibility.
- Ability to multi‑task in stressful, high‑volume environments and manage tight timeframes.
- Ability to remain composed under pressure.
- Good judgment and resourcefulness; ability to review information and draw appropriate conclusions; ability to escale issues as needed.
- Team‑oriented work ethic.
- Demonstrated ability to interpret patients’ insurance benefits and apply applicable contractual obligations.
- Critical thinking regarding issues with financially securing payment.
- Ability to discuss sensitive financial concepts with patients.
- Understanding of complex billing processes.
- Medical terminology knowledge.
- CHAA – Certified Healthcare Access Associate within 1 year – required.
Physical Demands
- Standing – occasionally.
- Walking – occasionally.
- Sitting – frequently.
- Feeling – occasionally.
- Talking – frequently.
- Hearing – frequently.
- Repetitive motions – frequently.
- Eye/hand/foot coordination – rarely.
Albany Medical Center is an equal opportunity employer.
The role may require access to sensitive information considered confidential, including HIPAA-protected health information. Workforce members must adhere to a "need to know" access policy and protect information from unauthorized access or disclosure.
