Financial Case Manager Lead

Rochester Regional Health

4d•$27 - $30

About The Position

The Lead Financial Case Manager under the direction of the Supervisor leads a team in the support of determining eligibility for Medicaid and other government health insurances, community-based and fiscal programs for patient and families. Develops patient needs-based plan, coordinates services, participates in discharge planning and follows through to completion.

Requirements

BA/BS in related field with 2 years’ experience, or AAS in related field with four years’ experience, or an equivalent combination of work experience and education and certificates will be considered.
Maintain a valid NYS license for transportation to meetings/appointments.
If working with Presumptive Eligibility programs, specific program certification will be required.
NYS DL - valid New York State Driver's License - New York State Department of Motor Vehicles (NYSDMV)New York State Department of Motor Vehicles (NYSDMV)
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

Nice To Haves

An equivalent combination of work experience/education/certificates will be considered
Bilingual preferred
Knowledgeable about a variety of health programs (Medicaid, federal, state, local and grant-funded)
Demonstrated experience working with diverse populations
Basic computer skills and programs proficiency
Maintain a valid NYS license for transportation to meetings/appointments
Demonstrate leadership skills.
Knowledgeable of a variety of health programs from Medicaid, federal, state, local and grant-funded programs; their regulations, processes and financial eligibility qualifications.
Demonstrated experience working with diverse populations.
Bilingual preferred.
Basic computer skills and programs proficiency.

Responsibilities

Leads a Financial Case Manager team members in doing the equivalent work, assigns work to others and provides oversight, provides input to supervisor regarding team members’ performance and /or need for disciplinary actions; performs most complex tasks or procedures; serves as a resource to others in the resolution of complex issues, patient cases or technical skills.
Provide team members with necessary tools and training for Maximum understanding of job responsibilities.
Provide retraining and coaching team members as needed.
Initiate quality review of case notes and applications of team members.
Ensure self-pay patients are being met with by a Financial Case Manager.
Participate in brainstorming sessions for problem solving difficult cases with team members.
Support the department’s efforts in the development of the Financial Case Manager’s team, processes and reports to ensure Participate in any work group, committee or task force as needed to ensure the accurate timely.
Assess under and uninsured patient and families for community, urgent and chronic care health care coverage and payer opportunities. This may include NYS/ other state, federal entitlement programs, and community –based programs
Review self-pay census to identify under and uninsured.
Receives referrals from community agencies and internal health care team members.
Initiates contacts with patient/family/representative to assess necessary assistance and prioritization of needs.
Maintains reports, provide necessary documents and data by deadlines and upon request of supervision.
Documentation according to policies and procedures, and in the patient medical record for all patients .
Understanding of the verification process through insurance websites, and basic understanding of PFS billing process.
Other duties as assigned.
Implements effective plan to facilitate eligibility determination
Obtain RGHS release of information, completion of Medicaid application, necessary Department of Social Services forms; explain Medicaid and FINA processes, and follow-up needs.
Attends appointments at DSS and or other agencies with/or to represent patients as appropriate.
Assist and facilitate in obtaining necessary Medicaid or health program eligibility documents.
Upholds HIPPA and RGHS policies and procedures throughout process.
Facilitates working relationships with counties and other government agencies.
Completes Plan Completes clear action plans, prioritization of case load to move each case to closure.
Serves as liaison between patient and families, RGHS Patient Financial Services, RGHS Affiliates, and community agencies
Collaborate effectively with interdisciplinary teams.
Maintains confidentiality throughout case management process.
Participates in Hospital, affiliate and departmental committees where appropriate.
Voluntarily participates in RGHS activities and department sub teams.
Participates in regular exchanges of information and presentations among Financial Case Managers, RRH team members and community agencies when appropriate.
Provides input and potential resolution to supervisor on policies and/or procedures.
Collaborate with relative local community-based organizations, health care agencies, state, county and local government offices informing them of available services that benefit their constituencies.
Stays current with local, state and federal changes that relate to Medicaid and health care access and reimbursement.
Submits required ideas for improvements via RGHS JDI’s and DIGs.
Assist in the training and assimilation of new team members during orientation and throughout their probationary period.
Educates patients and RGH team members on job roles, processes and programs as appropriate.
Demonstrates an understanding of the diversity and culture of the various populations served.
Cross training with other departmental team members to enhance knowledge and skill base and to foster team building and cross coverage as necessary.
Maintains leadership standards, participates in peer interview to hire quality team members.