Insurance and Cost Estimate Representative in Scotland

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 escalate 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.