The Patient Cost Estimation Specialist reports to the manager of the Cost Estimation Team. The Specialist utilizes high-level customer service, healthcare finance and revenue cycle knowledge, and excellent communication skills. The Specialist has a detailed understanding of price transparency regulations, including but not limited to the No Surprises Act of 2020, and how it relates to challenges in a complex health care environment. This person is the primary contact for patient-families and colleagues seeking to understand financial care of services to be delivered.

The Patient Cost Estimation Specialist works closely with authorization, financial advocate, clinical representatives, and business stakeholders in order to most accurately provide estimated cost for patient-families. This person has extensive knowledge of patient benefit design and care delivered by Nemours in order to effectively help a patient-family understand how it relates to their scheduled procedure or service. They do this in a way that upholds a patient-centered model of care delivery and Nemours' values and standards of behavior.

Responsibilities:

1. Identify how an individual's planned service will relate to their specific payor and plan design, including but not limited to tiers and benefit levels.
2. Based on historical data, patient-specific information, and authorizations, identify the appropriate CPTs for which to estimate.
3. Deliver and communicate the patient cost estimate to both patient-families and providers, as applicable.
4. Discuss financial options with families. Collect pre-payments from patient-families.
5. Meet all regulations in regard to the No Surprises Act.
6. Builds and maintains effective enterprise-wide relationships with clinical team members, business operations, various department representatives, authorization specialists, financial advocates, and other stakeholders, as applicable.

Qualifications:

• High School Diploma Required
• Healthcare experience required
• Certified Revenue Cycle Representative (CRCR) required within first 12 months