Health insurance and authorization representative iii Job at University of Rochester (Rochester)

Health insurance and authorization representative iii

University of Rochester

Location:
United States of America , Rochester

Category:
Customer Service

Contract Type:
Not provided

Salary:

19.62 - 26.49 USD / Hour

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Job Description:

Manages and provides financial account management for all urgent, emergent, and pre-admission visits with a Surgery Admit and Inpatient/Outpatient levels of care. Coordinates all activities necessary to financially secure the defined case load through verifying insurances, requesting deposits for non-covered services and co-pays. Identifies complex problems, including but not limited to, authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. Communicates, collaborates, and follows-up with patients, families, third-party payers, governmental agencies, employers, social work, financial case management, clinical team and contracting. Minimizes any delays from admission until the final bill is produced and any payer denials associated with the above.

Job Responsibility:

Manages and provides financial account management for all urgent, emergent, and pre-admission visits with a Surgery Admit and Inpatient/Outpatient levels of care
Coordinates all activities necessary to financially secure the defined case load through verifying insurances, requesting deposits for non-covered services and co-pays
Identifies complex problems, including but not limited to, authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues
Communicates, collaborates, and follows-up with patients, families, third-party payers, governmental agencies, employers, social work, financial case management, clinical team and contracting
Minimizes any delays from admission until the final bill is produced and any payer denials associated with the above
Reviews each visit for insurance history by utilizing the hospital system along with all third-party payer systems
Obtains benefits, pre-certification requirements, and/or completes notification of admissions
Documents demographic and insurance information in a timely, accurate manner in the hospital computer system, following department and hospital standards
Identifies and confirms uninsured and underinsured patients for appropriate referral to Financial Case Management for possible Medicaid application and/or Financial Assistance
Notifies and monitors patients for completion of adding newborns onto policy
Determines the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits
Notifies Utilization Management of clinical requests by third party payers
Maintains a monitoring system for adequate benefit coverage and eligibility throughout the inpatient stay
Reviews payer denials and communication from Patient Financial Services related to Financial Counseling responsible areas and performs necessary follow-up to secure payment
Notifies and monitors patients COBRA entitlement and assists with paperwork if necessary
Monitors current admissions to ensure eligibility and additional clinical requirements
Develops a process to monitor caseload, documents thoroughly in the hospital financial system and communicates essential information to appropriate parties in a timely and accurate manner
Observes work queue daily for potential cases that may require notification to insurance company and provides within payer designated timeframe
Works to identify barriers to securing cases and develop and implements a plan to successfully resolve issues
Utilizes resources and investigational skills to solve unique and complex problems
Verifies Medicaid eligibility every 30 days for active coverage
Reviews Medicare for MSP questions and validations
Investigates and corrects any discrepancy between MSPQ and patient registration
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
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
Assists with communication and coordination of activities with multiple areas within the University of Rochester Medical Center System
Communicates with external parties such as patients, families, third party payers, Department of Social Services, Department of Health, 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

Requirements:

High School diploma or equivalent and 2 years of related experience, preferably in a hospital setting required
Associate's degree preferred
Or equivalent combination of education and experience
High degree of professionalism and motivation with excellent communication and customer service skills required
Strong ability to multi-task and prioritize required
Flexibility to work weekends, other assigned hours required
Familiarity with Medical terminology required
Strong computer skills and ability to type 45 words per minute preferred

Nice to have:

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

Additional Information:

Job Posted:
February 21, 2026

Employment Type:

Fulltime

Work Type:

On-site work

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