Telehealth Benefits Specialist

Location: Remote
Annual Salary: $79,844

Job Summary:
We seek a dedicated and knowledgeable Telehealth Benefits Specialist to join our team remotely. This individual will be critical in helping patients and healthcare providers navigate telehealth services and ensure they maximize the benefits available through various health plans. As a Telehealth Benefits Specialist, you will be responsible for educating, assisting, and troubleshooting issues related to telehealth benefits, eligibility, and claims processing. This position involves interacting with patients and providers, making communication skills and a deep understanding of healthcare benefits essential.

Key Responsibilities:

1. Patient Assistance and Education
   • Serve as the primary point of contact for patients seeking information about their telehealth benefits, coverage, and eligibility.
   • Educate patients on accessing telehealth services, including scheduling appointments, understanding co-pays, and using the telehealth platform.
   • Educate patients about their health plan's benefits, including what services are covered, exclusions, and limitations specific to telehealth care.
   • Help patients understand how telehealth services interact with their in-network and out-of-network benefits, including referrals, pre-authorizations, and cost-sharing responsibilities.
2. Provider Support and Coordination
   • Work with healthcare providers to ensure they know patients’ benefits related to telehealth services and any specific requirements for claims.
   • To ensure timely reimbursement, assist providers in understanding the billing codes and processes associated with telehealth services.
   • Troubleshoot provider concerns regarding denied claims or discrepancies in benefits related to telehealth services, ensuring prompt resolution.
   • Coordinate with providers to resolve any authorization or billing issues related to telehealth care.
3. Claims Processing and Resolution
   • Process telehealth-related claims promptly, ensuring all claims are accurately documented and submitted.
   • Research and resolve denied or incorrectly processed claims, working with insurance companies and providers to reconcile discrepancies.
   • Track claims to ensure appropriate payment and follow up on outstanding claims or payment issues.
   • Assist patients and providers with appeal processes when claims are denied, including gathering necessary documentation and submitting appeals to insurance carriers.
4. Benefits Analysis and Optimization
   • Analyze and interpret various health plan documents, policies, and contracts to ensure accurate telehealth benefit determination for patients and providers.
   • Identify opportunities to optimize patients’ use of telehealth benefits, such as suggesting supplemental services or coordinating care with in-network providers.
   • Provide detailed benefit breakdowns to patients, outlining coverage, deductibles, co-pays, and out-of-pocket maximums for telehealth services.
   • Stay up-to-date with changing health plan regulations, policies, and telehealth service offerings to provide accurate and relevant information to patients and providers.
5. Customer Service and Communication
   • Deliver exceptional customer service by responding to inquiries via phone, email, and chat promptly and professionally.
   • When assisting patients with questions about their telehealth benefits, take a compassionate and empathetic approach, understanding the importance of clear and concise communication.
   • Handle escalated inquiries and complaints with professionalism and work to resolve any issues promptly.
   • Build positive relationships with patients, providers, and internal teams by consistently delivering accurate and helpful information.
6. Documentation and Compliance
   • Using internal systems, maintain accurate records of patient interactions, benefit inquiries, claims submissions, and resolutions.
   • Ensure that all interactions comply with HIPAA regulations and company privacy policies.
   • Document all claims, benefits explanations, and resolutions for future reference, ensuring consistency and transparency.
   • Provide reports on telehealth usage, claims processing, and benefits-related inquiries to internal teams for review and improvement of telehealth services.

Qualifications:

• Education and Experience:
  • A bachelor’s degree in healthcare administration, health information management, or a related field is preferred.
  • At least 3 years of experience working in a healthcare benefits, claims processing, or telehealth environment.
  • Experience working directly with health insurance plans, including Medicare, Medicaid, and private insurance carriers.
• Skills and Abilities:
  • Strong understanding of healthcare benefits and insurance policies, specifically as they relate to telehealth services.
  • Proficient in claims processing and reimbursement protocols for telehealth services.
  • Excellent communication skills, both written and verbal, with the ability to explain complex healthcare benefits clearly and understandably.
  • Strong organizational skills and attention to detail, with the ability to manage multiple inquiries and tasks simultaneously.
  • Problem-solving skills and the ability to navigate complex insurance and billing issues.
  • Familiarity with HIPAA regulations and patient privacy standards.
  • Proficient in using customer service software, claims management systems, and telehealth platforms.

Working Conditions:

• This is a fully remote position, allowing flexibility in work location.
• You will be expected to work standard business hours, with occasional need for extended hours during high-volume periods.
• Reliable internet access and a suitable home office environment are required to support the demands of this role.

Compensation and Benefits:

• Annual Salary: $79,844.
• Comprehensive benefits package including health, dental, and vision insurance, retirement plans, and paid time off.
• Ongoing opportunities for professional development and growth within the organization.