Health Insur & Auth Rep IV

University of Rochester•City of Rochester, NY

4d•$21 - $28•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.

Requirements

High School diploma or equivalent and 3 years of related experience, preferably in a hospital setting required
Ability to work independently as well as in a team environment required
Ability to work with a diverse population, including physically handicapped, mentally ill, drug and alcohol dependent patients and family members required
Excellent written and verbal communication and customer service skills required

Nice To Haves

Associate's degree preferred
Strong computer skills and ability to type 45 words per minute preferred

Responsibilities

Manages and provides financial account management for assigned caseload.
Identifies and determines the accuracy and completeness of insurance and demographic information to ensure case is secure prior to discharge.
Identifies problems, including but not limited to, pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal processes.
Communicates and follows-up with assigned area, Financial Assistance, Social Work, Utilization Management, Financial Case Management, patients, families, third-party payers, and governmental agencies.
Documents demographic and insurance information in a timely, accurate manner in the hospital computer system, following department and hospital standards.
Assesses each account for benefits, authorizations, self-pay balances, or other concerns that may potentially result in payment or discharge issues.
Monitors caseload and documents information regarding insurance and exhausted benefits for timely follow-up and referrals.
Tracks patients unable to participate in insurance management due to cognitive barriers or medical intensity and ensures their or surrogate representative’s ultimate participation in the case management process.
Performs ongoing case management for continuous coverage on all Medicaid, Out of State Medicaid, and Medicaid Managed Care cases for appropriate follow-up and timely referral to Financial Case Management team.
Develops process to monitor caseload, documents thoroughly in the hospital financial system and communicates essential information to appropriate parties in a timely and accurate manner.
Identifies barriers to securing cases and develops and implements a plan to successfully resolve issues.
Identifies areas and recommendations for process/operational improvement.
Utilizes resources and investigational skills to solve unique and complex problems.
Delegates tasks in times of absence or high work volume and provides guidance and quality assurance of work.
Reviews Medicare for MSP questions and validations.
Ensures compliance with the Office of the Inspector General guidelines by notifying patients of exhausting Medicare benefits and the option to utilize lifetime reserve days.
Ensures appropriate documentation is on file for assigned caseload.
Maintains a thorough knowledge of insurance carriers’ policies and benefit levels as it relates to each specialty.
Assists in communication and coordination of activities with multiple areas within the University of Rochester Medical Center System.
Coordinates with external parties, including patients, families, physician offices, third party payers, Department of Social Services, Department of Health, police departments, attorneys, outside hospitals, governmental agencies and external review agencies.
Explains workflow and policies to areas of impact.
Provides training and resources to all coverage and those within URMC/affiliates.
Creates a professional and effective customer-oriented environment by utilizing excellent communication skills to obtain pertinent demographic information.
Confirms insurance information and discuss financial obligation.
Other duties as assigned.