High Cost Case and Radiation Oncology Specialist

Rochester, NY

POSITION SUMMARY:

Coordinates all aspects of patient financial account management for accounts defined by the High Cost Committee, including in-house and discharged patients. 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 are 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 Financial Counselors and Coordinators, patients, families, third-party payers, governmental agencies and other areas of the Strong Health System. Seeks out better methods for those processes for which Specialist is responsible. Specialist works independently and solves problems quickly as they arise. Specialist is ultimately responsible for minimizing time from patient discharge to payment through early intervention and problem resolution. Specialist also provides Financial Counseling coverage for Radiation Oncology Department.

This role may have the option to work a hybrid-remote schedule and communicate daily through virtual meetings.

SUPERVISION AND DIRECTION EXERCISED :

Responsible for monitoring own performance on assigned tasks. Self-directed: must make complex decisions independently. Provides direction to other areas of University of Rochester Medical Center for account resolution. May assist in training other Strong Health staff.

MACHINES AND EQUIPMENT USED :

Standard office equipment, including but not limited to: telephone, page system, pneumatic tube system, personal computers, printer, photo copier, fax, RightFax, EPIC, Outlook, and electronic third-party payer systems.

ESSENTIAL DUTIES :

Customer Interactions - 10%

  • Speaks with patients, colleagues, High Cost Committee team, and the Radiation Oncology team utilizing professional and excellent communication skills that focus on delivering clear and accurate information about account management, patient’s financial obligations- quoted insurance benefits, the difference between copayments and coinsurance, and any benefit caps in place. Utilizes other resources, such as our Financial Case Management and/or Financial Assistance program to assist patients who do not have the financial resources to meet their healthcare obligations.

Financial Account Management - 75%

  • Runs and Screens High Cost Report to determine cases that meet high cost criteria.

  • Reviews ALC Report to ensure patients have appropriate coverage for all dates of service.

  • Assesses each account for continued coverage, benefits, authorizations, diagnosis, filing order and coordination of benefits, self-pay balances, ALC, discharge planning 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.

  • Identifies cases that require legal intervention and notifies appropriate liaisons.

  • Communicates and coordinates activities with multiple areas of Strong Health System: Financial Counseling, Financial Case Management, Utilization Management, Patient Financial Services, Social Work, Medical Records, Finance, and Legal.

  • Communicates and coordinates activities with external parties: patients, families, physician offices, third party payers, Department of Social Services, governmental agencies, and external review agencies.

  • Follows unresolved cases after discharge to ensure case management and billing readiness.

  • Manages high cost cases and reports to Financial Counseling Managers in order to examine pending case load and outstanding accounts.

  • Uses personal judgment and initiative to anticipate and develop constructive solutions to challenges and obstacles in the financial clearance process.

  • Reviews Radiation Oncology Department Appointments Report to verify insurance information prior to contacting the patient to discuss insurance benefits and documentation required for their first visit.

  • Consults financial options with patients who have no, out-of-network, restrictive or limited coverage and are considering treatment/further treatment at URMC. Informs Radiation Oncology team of patient’s status. Identifies and confirms self-pay patients for appropriate referral to Financial Case Management for possible Medicaid application and /or Financial Assistance.

  • Notifies the Radiation Oncology team of any insurance changes for a patient during treatment in order to ensure the treatment plan is authorized to secure reimbursement.

Monitoring/Process Improvement/Training - 15%

  • 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. Identifies areas and recommendations for process/operational improvement. Trains covering designee.

  • Ensures team performance against established goals.

  • Observes visits on the Radiation Oncology DAR daily for potential cases that may require missing registration, insurance, and authorization resolution.

Performs other related duties as assigned.

QUALIFICATIONS :

Associates Degree in a related area with 3 years of related experience (Financial Counseling, Registration, third-party payors) preferably in a hospital setting or equivalent combination of education and experience. Requires a high degree of professionalism and motivation with excellent written and verbal communication and customer service skills; ability to work independently as well as in a team environment; highly collaborative; self-starter; strong computer skills and ability to type 45 words per minute. Prefer medical terminology. Flexible to work other assigned hours and/or responsibilities as needed.

Note: This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

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.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $ 19.00 - $ 24.70 Hourly

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.

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Location: Strong Memorial Hospital
Full/Part Time: TAR
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