Health Insur & Auth Rep III

University of Rochester • City of Rochester, NY

26d • $20 - $26 • Onsite

About The Position

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. The individual in this position manages and provides financial account management for all assigned caseloads. Accountable for coordinating all activities necessary to financially secure the defined accounts through verifying insurances, requesting deposits for non-covered services and co-pays. Identifies complex problems that include but are not limited to authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. This role involves in-depth communication, collaboration, and follow-up with patients, families, third-party payers, governmental agencies, employers, social work, financial case management, clinical team and contracting. The Health Insurance & Auth Rep is ultimately responsible for minimizing any delays from admission/arrival until the final bill is produced and any payer denials associated with the above.

Requirements

• High School Diploma or equivalent required
• 2 years of related experience, preferably in a hospital setting, or equivalent combination of education and experience required
• High degree of professionalism and motivation with excellent communication and customer service skills required
• Strong ability to multi-task and prioritize required.
• Flexible to work weekends, other assigned hours and/or responsibilities as needed required

Nice To Haves

• AAS Degree preferred
• Strong computer skills and ability to type 45 words per minute preferred.
• Medical terminology preferred.

Responsibilities

• Customer Interactions Create a professional and effective customer-oriented environment by utilizing excellent communication skills to obtain pertinent demographic information. Confirm insurance information and discuss financial obligation. Display a high degree of professionalism and motivation with excellent written and verbal communication and customer service skills.
• Financial Management Review each visit for insurance history by utilizing the hospital system along with all third-party payer systems. Obtain benefits; pre-certification requirements and/or completes notification of admissions. Document demographic and insurance information in a timely, accurate manner in the hospital computer system following department and hospital standards. Identify and confirm uninsured and underinsured patients for appropriate referral to Medicaid Enrollment & Outreach for possible Medicaid application and /or Financial Assistance. Notify and monitor patients for completion of adding newborns onto policy. Determine the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits. Notify Utilization Management of clinical requests by third party payers. Maintain a monitoring system for adequate benefit coverage and eligibility throughout the inpatient stay. Review payer denials and communication from PFS related to Health Insurance Counseling responsible areas and perform necessary follow-up to secure payment. Notify and monitor patients COBRA entitlement and assist with paperwork if necessary.
• Compliance Review Medicare for MSP questions and validations. Investigates and corrects any discrepancy between MSPQ and patient registration. Ensure compliance with the Office of the Inspector General guidelines by notifying patients of exhausting Medicare benefits and the option to utilize lifetime reserve days. Ensure appropriate documentation is on file for assigned caseload. Maintain a thorough knowledge of insurance carriers’ policies and benefit levels as it relates to each specialty.
• Quality Management Consistently monitor current admissions to ensure eligibility and additional clinical requirements. Develop a process to monitor caseload, document thoroughly in the hospital financial system and communicate essential information to appropriate parties in a timely and accurate manner. Observe workqueue daily for potential cases that may require notification to insurance company and provide within payer designated timeframe. Identify barriers to securing cases and develop and implement a plan to successfully resolve issues. Utilize resources and investigational skills to solve unique and complex problems. Re-check Medicaid eligibility every 30 days for active coverage. May train or perform other duties assigned by management.
• Interdisciplinary Processes Involves the communication and coordination of activities with multiple areas within the University of Rochester Medical Center System: Health Insurance Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records, Surgeon offices, Prior Authorization Teams, Contracting and Finance. External coordination includes patients, families, third party payers, Department of Social Services, Department of Health, attorneys, MVA and WC carriers, outside hospitals, governmental agencies, and external review agencies. Explain workflow and policies to areas of impact. Provide training and resources to all coverage and those within URMC/affiliates.
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED