Health Insur & Auth Rep III

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.

Job Location (Full Address):

601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening

Worker Subtype:

Regular

Time Type

Full time

Scheduled Weekly Hours

40

Department

500183 Financial Counseling&Outpt Reg

Work Shift

UR - Day (United States of America)

Range

UR URC 205 H

Compensation Range

$19.62 - $26.49

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities

GENERAL PURPOSE:

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.

Essential Functions

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.
  
  

Qualifications

Other duties as assigned

• High School Diploma or equivalent required.
• AAS Degree preferred.
• 3 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 computer skills and ability to type 45 words per minute preferred.
• Strong ability to multi-task and prioritize required.
• Medical terminology preferred.
• Flexible to work weekends, other assigned hours and/or responsibilities as needed required.
  
  

EOE Minorities / Females / Protected Veterans / Disabled

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.