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Patient Benefit Specialist

Job ID R1147 Full / Part Time:Full time


The Patient Benefits Specialist is responsible for home care authorization functions of patients at Baystate Home Health & Hospice.Depending on the needs of the department, the Patient Benefits Specialist may, in addition, be assigned responsibility for billing any accounts within the home care program as well.Knowledge of various payer policies and regulatory requirements is critical to the successful completion of his/her job responsibilities.This position submits authorization requests for services rendered in accordance with payer policies/requirements.Responsibilities include: submitting timely authorization requests, follow-up on denials, entering approvals quickly and working with other departments to ensure billing is able to be done timely.

Job Responsibilities: 

1)Authorization requests within assigned service area, updates data in EMR, excel spreadsheets and other analytical tools, and enters coordination notes into EMR.

2) Works with insurance companies and government payers to resolve authorization denials including filing of appeals.

3) Customer Service and Team Building:Demonstrated interpersonal skills to foster teamwork.Understands and demonstrates Baystate Home Health and Hospice Operating principles.Adheres to system and department compliance policies and applicable laws and regulation.

4) Answer, record and relay telephone messages in a timely manner using positive customer service skills.Maintains effective communication with all members within the department, other departments and contacts outside the organization.

5) Demonstrates proficiency in performance of computer-related activities, e.g. word processing, spreadsheet development, use of statistical packages, and computer programs.

6) Sets priorities for work assigned, separates work requiring immediate attention from regular work and completes assignment within required time frame and minimal supervision.

7) Will be responsible for cross-training with billing and collections as well as other functions within the billing/authorization department as needed.

Required Work Experience: 

1)Minimum of two years professional office experience

Preferred Work Experience: 

1)Minimum of two years professional experience in a healthcare environment

Skills and Competencies: 

1)Ability to enter complex data with speed and accuracy for extensive periods of time and be detail-oriented.

2)  Knowledge of software and data base

3) Critical thinking, sound judgment

4)  Knowledge of healthcare terminology

5)  Ability to identify, evaluate and solve problems and manage multiple priorities

6)  Excellent customer service skills


GED or HiSET (Required)



Work Experience:




Training Details:

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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