Price Estimation Rep III

University of Rochester•New York, NY

1d•$21 - $29•Remote

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. This role is responsible for assessing all aspects of providing an accurate estimate of both insurance coverage and out-of-pocket costs for patient healthcare. The Price Estimation Representative III addresses inquiries related to the cost of health care services and/or billing inquiries. They evaluate and process incoming Good Faith estimates, as well as incoming inquiries from internal and external customers via phone, email, and correspondence. The role involves explaining and referring patients and/or families to UR Medicine Financial Assistance programs and other available payment options. They obtain benefit information from third-party payers to advise patients on expected out-of-pocket costs and act as a liaison between patients and providers. The position requires developing and utilizing contacts at all patient care locations to provide accurate information, retrieving and disseminating insurance fee schedules and reimbursement matrices, and performing contract reviews to ensure proper reimbursement rates are utilized. The representative will complete system documentation, generate patient estimation letters, and ensure departmental standards for accurate and timely financial estimation are met. Accountability also extends to meeting Public Health Service Act standards and providing Good Faith estimates. The role includes developing audit procedures to ensure accuracy, reviewing estimates and services for discrepancies, and making recommendations to leadership for corrections. Other duties as assigned.

Requirements

Bachelor's degree and 3 years of relevant experience required
Or equivalent combination of education and experience

Responsibilities

Assesses all aspects of providing an accurate estimate of both insurance coverage and out-of-pocket costs for all matters concerned with patient health care.
Addresses inquiries related to the cost of health care service and/or billing inquiries.
Evaluates and processes incoming Good Faith estimates, as well as incoming inquiries from internal and external customers from phone calls, emails, and correspondence.
Explains and refers patients and/or families, as appropriate, to the UR Medicine Financial Assistance programs offered by the University.
Explains other payment options that may be available and offered, as appropriate.
Obtains benefit information from third party payers to advise patients on their expected out-of-pocket costs related to deductibles, coinsurance, copayments or total charges if services are non-covered.
Acts as liaison between patients and providers.
Develops and utilizes contacts at all patient care locations to provide accurate information based on the provider or department.
Retrieves and disseminates the insurance fee schedule and insurance reimbursement matrixes.
Performs contract reviews and ensures the proper reimbursement rates are utilized by determining if payments will be based on diagnosis-related group (DRG), Ambulatory Payment Classifications (APC), fee schedule, percentage of charges, or other defined methods.
Completes appropriate system documentation notes regarding the estimate provided to the patient.
Provides and generates patient estimation letter which details the anticipated cost and patient responsibility for those services quoted.
Has accountability for meeting departmental standards for accurate and timely financial estimation for traditional requests to both patients and providers.
Has accountability for meeting Public Health Service Act standards and providing a Good Faith estimate.
Develops audit procedures to ensure the accuracy of the information given to customers.
Completes reviews of estimates and services received to determine if there are any discrepancies in the rates quoted.
Makes recommendations to leadership on how to correct these discrepancies in the future.
Other duties as assigned.