Insurance Discovery and Estimate Representative

Insurance Discovery and Estimate Representative

Join to apply for the Insurance Discovery and Estimate Representative role at Albany Medical Center
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Department / Unit:
Patient Access

Work Shift:

Day (United States of America)
Salary Range: $41,136.28 - $57,590.79

The Insurance Discovery and Estimate Representative has a strong working knowledge of third‑party payer regulations and interprets payer contracts to ensure accurate payment and estimates. The role serves as the liaison for challenging encounters, collaborates with the Enrollment Service Partner to ensure timely disposition for Medicaid Pending encounters, and supports department operations to secure financial responsibility prior to discharge.

• Review all self‑pay encounters to identify insurance coverage or determine referral to the Enrollment Service Partner.
• Assess challenging encounters from Out of State and International sources to secure payment.
• Provide accurate estimates in support of the No‑Surprise Act, Good Faith Estimates, and Financial Aid Policy.
• Explain insurance benefits and self‑pay estimates to patients, including collection of balances owed.
• Review and reconcile Medicaid Pending inventory to ensure timely disposition.
• Review eligibility responses and determine benefits to ensure 100% coverage for inpatient and outpatient services.
• Explain financial responsibility and associated policies to clinic staff, outside providers, and patients.
• Support department operations to ensure encounters are financially secured prior to discharge.
• Collaborate with colleagues across the Albany Med Health System to meet workload expectations as a team.
• Contribute to a compassionate and caring environment through kindness, active listening, and appreciation of each employee’s value.

• Associate’s Degree – required.
• Bachelor’s Degree – preferred.
• 3–5 years working knowledge of 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 skills for successful resolution.
• Proven customer‑service skills with ability to exceed expectations in sensitive patient interactions.
• Ability to analyze encounter history to secure financial responsibility.
• Strong multitasking ability in high‑volume, high‑pressure environments.
• Composure under pressure and effective problem‑solving skills.
• Team‑mindful work ethic.
• Ability to interpret patient’s insurance benefits and apply contractual obligations.
• Medical terminology knowledge.
• CHAA – Certified Healthcare Access Associate within 1 Year – required.

• Standing – Occasionally.
• Walking – Occasionally.
• Sitting – Frequently.
• Feeling – Occasionally.
• Talking – Frequently.
• Hearing – Frequently.
• Repetitive motions – Frequently.
• Eye/hand/foot coordination – Rarely.

Thank you for your interest in Albany Medical Center!

Albany Medical Center is an equal‑opportunity employer. This role may require access to sensitive information, including HIPAA‑protected health information. Workforce members must use a “need to know” basis and adhere to policies to protect information.