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The Patient Estimate Specialist is responsible for the accurate and timely preparation of patient estimates for scheduled services across University Health. This position serves as a subject matter resource for the Good Faith Estimate (GFE) process for uninsured and self-pay patients, as well as estimates for insured patients based on available insurance benefits, contracted rates, patient responsibility, and University Health pricing.

The Patient Estimate Specialist works closely with scheduling, Patient Access, Financial Counseling, clinical departments, coding, billing, and other Revenue Cycle teams to ensure patients receive clear and accurate information regarding their anticipated financial responsibility prior to receiving services. This position also proactively communicates with patients regarding estimated balances and payment expectations and assists patients in identifying available financial assistance or payment options.

The position requires a strong understanding of medical coding, insurance benefits, reimbursement methodologies, hospital and physician charges, and Revenue Cycle processes. The Patient Estimate Specialist must be able to review clinical services and associated codes to ensure estimates accurately reflect the services expected to be provided.

Minimum Requirements

1.     Associate degree in a related healthcare, business, or Revenue Cycle field, or equivalent combination of education and experience.

2.     Three years of experience in healthcare Revenue Cycle, medical billing, coding, patient estimates, financial clearance, or a related healthcare financial services function.

3.     Working knowledge of medical terminology, CPT/HCPCS coding, hospital and/or professional charges, insurance benefits, and patient financial responsibility.

4.     Strong understanding of medical coding and the ability to review procedure and service information to support accurate patient estimates.

5.     Excellent verbal and written communication skills with the ability to explain complex financial and healthcare information in simple, patient-friendly language

6.     Professional demeanor and excellent customer service skills, particularly when communicating with patients regarding financial responsibility and payment expectations

7.     Excellent organizational skills with the ability to manage multiple estimates, deadlines, patient contacts, and work queues

8.     Strong attention to detail and demonstrated ability to identify discrepancies in coding, charges, insurance benefits, and patient responsibility

9.     Computer proficiency in Microsoft Office Suite, electronic medical record systems, estimating applications, and other Revenue Cycle systems.

10.  Ability to work independently while also collaborating effectively with Patient Access, Financial Counseling, Coding, Billing, clinical departments, and other Revenue Cycle teams.

Preferred Qualifications

1.     Certified Professional Coder – Apprentice (CPC-A) or Certified Professional Coder (CPC) certification

2.     Experience preparing Good Faith Estimates under the No Surprises Act

3.     Experience preparing hospital and/or physician estimates for insured and self-pay patients

4.     Experience with medical coding, charge capture, reimbursement, or claims processing

5.     Experience with insurance benefit verification and calculation of patient financial responsibility

6.     Cerner/Oracle Health or other electronic medical record experience

7.     Experience with patient estimating, financial clearance, or Revenue Cycle estimating applications

8.     Experience working in a hospital or academic medical center environment