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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.
Job Responsibility:
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
Minimizing any delays from admission/arrival until the final bill is produced and any payer denials
Create a professional and effective customer-oriented environment
Confirm insurance information and discuss financial obligation
Review each visit for insurance history
Obtain benefits
pre-certification requirements and/or completes notification of admissions
Document demographic and insurance information
Identify and confirm uninsured and underinsured patients for appropriate referral
Notify and monitor patients for completion of adding newborns onto policy
Determine the primary payer
Notify Utilization Management of clinical requests by third party payers
Maintain a monitoring system for adequate benefit coverage and eligibility
Review payer denials and communication from PFS
Notify and monitor patients COBRA entitlement and assist with paperwork
Review Medicare for MSP questions and validations
Ensure compliance with the Office of the Inspector General guidelines
Ensure appropriate documentation is on file
Maintain a thorough knowledge of insurance carriers’ policies and benefit levels
Consistently monitor current admissions to ensure eligibility and additional clinical requirements
Develop a process to monitor caseload, document thoroughly and communicate essential information
Observe workqueue daily for potential cases
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
Involves the communication and coordination of activities with multiple areas within the University of Rochester Medical Center System
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
Requirements:
High School Diploma or equivalent
3 years of related experience, preferably in a hospital setting, or equivalent combination of education and experience
High degree of professionalism and motivation with excellent communication and customer service skills
Strong ability to multi-task and prioritize
Flexible to work weekends, other assigned hours and/or responsibilities as needed
Nice to have:
AAS Degree
Strong computer skills and ability to type 45 words per minute