Health Insur & Auth Rep IV

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.

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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 

• Document demographic and insurance information in a timely, accurate manner in the hospital computer system following department and hospital standards.
• Assess each account for benefits, authorizations, self-pay balances, or other concerns that may potentially result in payment or discharge issues.
• Monitor caseload and document information regarding insurance and exhausted benefits for timely follow-up and referrals. 
• Track patients unable to participate in insurance management due to cognitive barriers or medical intensity and ensure their or surrogate representative’s ultimate participation in the case management process. 
• Perform 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 Medicaid Enrollment & Outreach. 

Quality Management

• 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. 
• Identify barriers to securing cases and develop and implement a plan to successfully resolve issues.
• Identify areas and recommendations for process/operational improvement. 
• Utilize resources and investigational skills to solve unique and complex problems.
• Work independently under self-direction.
• Delegate tasks in times of absence or high work volume and provide guidance and quality assurance of work.

Compliance

• Review Medicare for MSP questions and validations.
• 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.

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, Home Care Coordinators, Prior Authorization Teams, Contracting and Finance. 
• External coordination includes patients, families, physician offices, third party payers, Department of Social Services, Department of Health, police departments, 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.

Other duties as assigned

MINIMUM EDUCATION & EXPERIENCE

• High School Diploma or equivalent Required
• AAS Degree in related discipline (admitting/registration/patient billing/insurance) Preferred
• 3 years of related experience or equivalent combination of education and experience Required

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to work independently as well as in a team environment. Required
• Ability to work with all patient populations required.
• High degree of professionalism and motivation; highly collaborative. Required
• Excellent written and verbal communication and customer service skills. Required
• Strong computer skills and ability to type 45 words per minute. Preferred 

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture 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 characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.