University of Rochester Financial Coord in Rochester, New York
Full Time 40 hours Grade 009 Financial Counseling&Outpt; Reg
The Financial Specialist manages and provides financial case management for psychiatric, rehabilitation, epilepsy, International patients and High Cost cases. Identifies and determines in accordance with established policies and procedures the accuracy and completeness of insurance, demographic information, and signature on the patient care agreement form during pre-admission and/or admission to ensure case is secure prior to discharge. Identifies problems that include but not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payor issues, and denials/appeal processes. Involves in-depth communication and follow-up with social work, utilization management, patients, families, third-party payers, and governmental agencies. Collaborates with physician's office for International patients to manage the following needs prior to arrival: financial arrangements, including advance estimates for fees, deposits and payments; interpreter services; and lodging arrangements for patients and their families. Identifies and collaborates with high cost specialist on terminated Medicaid products. Cross covers for High Cost Specialist on no-fault and workers compensation visits. The Specialist is ultimately responsible for documenting service related admission authorizations, and tracking exhausted benefits for timely referral to Financial Case Management through caseload review, early intervention, and problem resolution. Seeks out better methods for those processes for which Specialist is responsible. High motivation required with attention to detail and the ability to learn quickly. Specialist works independently and solves problems quickly as they arise. Is the covering person for MV A and Workers Compensation during high volume and vacations.
- Case Tracking
- Assesses each account for benefits, authorizations, self-pay balances, or other concerns that may potentially result in payment or discharge issues.
- Identifies barriers to securing accounts and develops, coordinates and implements a plan to successfully resolve issues.
- Responsible for the strategy development and implementation plan necessary to financially secure each case.
- Involves the communication and coordination of activities with multi areas within the University of Rochester Medical Center System: Financial Counseling, Utilization Management, Social Work, Patient Accounts, Medical Records and Finance.
- External coordination includes patients, families, physician offices, third party payors, Department of Social Services, governmental agencies and external review agencies.
- Specific activities include obtaining detailed service related benefit limitations and authorization requirements.
- Ensures compliance with the Office of the Inspector General guidelines by notifying patients of exhausting Medicare benefits and the option to convert to lifetime reserve days.
- Monitors monthly and documents information regarding insurance and exhausted benefits for timely follow-up and referrals.
- Identifies and effectively communicates high risk cases to management.
- Facilitates resolution of patient billing issues.
- Identifies cases that require outreach intervention and notifies appropriate case manager.
- Complies with case closure standards.
- Tracks patients unable to participate in insurance management due to cognitive barriers or medical intensity and ensures their ultimate participation or surrogate representative in the case management process.
- Ability to work independently and with a diverse population including physically handicapped, mentally ill, drug and alcohol dependent patients and family members.
- Maintain frequent communication and follow-up with providers, patients, family members, Social Work, and management in meeting the personal needs of our international patients prior to their arrival to the U.S. (e.g., prepayment, interpreter services, lodging arrangements, etc.).
- Works with the prospective patient's foreign government if assuming financial responsibility for the patients medical care, then written pre-approval through the appropriate division of his/her embassy or other government office is required.
- Maintains a thorough knowledge of insurance carriers policies and benefit levels as it relates to each specialty.
- Assist with high cost cases by performing ongoing case management for continuous coverage on all Medicaid, Out of State Medicaid, and Medicaid Manage Care cases for appropriate follow-up and timely referral to Financial Case Management team.
- Interdisciplinary Process
- Collaborates with other areas such as Social work, Utilization Review, High Cost, and Patient Accounts to ensure rapid case resolution for high risk cases and to resolve any issues that may delay the billing process.
- Problem Resolution
- Identifies barriers to securing cases and develops and implements a plan to successfully resolve issues. Responsible for reviewing and tracking each case through a monitoring system as well as measurement against established goals.
- Monitoring/Process Improvement/Training
- Develops a process to monitor caseload, documents thoroughly the hospital financial system and communicates essential information to appropriate parties in a timely and accurate manner. Identifies areas and recommendations for process/operational improvement. Trains covering designee.
High school diploma and 4 years of related hospital credit services experience or Bachelor's degree in Business Administration, Health Care Administration, Psychology, or related discipline and 1 year of related experience; or equivalent combination of education and experience. Medical terminology required.
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Financial Coord
Location: Strong Memorial Hospital
Job ID: 209487
Full/Part Time: Full-Time