University of Rochester Price Estimation and Billing Analyst in Rochester, New York

Opening

Full Time 40 hours Grade 009 Pharmacy SMH

Schedule

DAYS/OCC WKENDS & HOLIDAYS

Responsibilities

General Job Description:

Under the supervision of the billing/intake manager, responsible for home infusion insurance verification and charge estimation, creation of charges, payment reconciliation processes and procedures with the primary focus on price estimation, billing/collections and compliance with payer standards including Medicare and other third party payers. Ensures proper coding of claim submissions to payer requirements, and works to monitor payments and resolve any third party issues. Expected to work independently and resolve and troubleshoot complex issues.

Responsibilities:

Price Estimation

Incoming inquiries and related information gathering

  • Retrieve and evaluate incoming home infusion referrals to verify insurance coverage and contract for infusion therapy and associated nursing.
  • Refer patients/families to UR Financial Assistance Team to get detailed financial information to better assist patients/families to receive proper medical care without financial burden.
  • Obtain benefit information from third party payers to advise patients on their expected out of pocket costs related to deductibles, coinsurance, copayments or total charges if services are not covered.

Outgoing Inquiries Related to Information Gathering and Relay of Estimate

  • Obtain benefit information from third party payers to advise patients on their expected out of pocket costs related to deductibles, coinsurance, copayments or total charges if services are not covered.
  • Acts as liaison between home care coordinators, discharge coordinators, home infusion staff and providers to obtain accurate information related to coding and services for home infusion billing.
  • Develop contacts within URMC to provide accurate information based on provider or department which includes but is not limited to: Highland, Strong Memorial, Offsite infusion and cancer centers, FF Thompson and other affiliate hospitals.

Reimbursement Review and Calculation of Costs

  • Retrieval and dissemination of both the insurance fee schedule and insurance reimbursement matrixes
  • Perform contract review and ensure proper reimbursement rates are utilized by determining if payments are part of home infusion per diems, drug or nursing charges.

Information Maintenance

  • Review individual payer reimbursement schedules and proactively update home infusion billing system on payer determined schedule
  • Maintain monitoring system to track inquiries and new referrals

Billing

Third party billing

  • Properly code claims for payment based on requirements from government and commercial payers to ensure prompt payment
  • Reconcile commercial Medicaid / Medicare claim payments
  • Analyze, resolve, and resubmit rejected/underpaid claims for payment
  • Correspond with insurance and patients related to billing
  • Prepare and send claims on a defined schedule

Problem Solving

  • Resubmit denied claims with any required information
  • Identify proactively problems with billing, payment or collections and resolve as needed
  • Participate in multidisciplinary teams for problem solving
  • Accurately handle deposits as needed
  • Contact manager when assistance is needed when solution is beyond expertise or authority
  • Work in conjunction with pharmacy finance to ensure accounts receivable balances are accurate and payments are applied correctly

Other Responsibilities

  • Manage special payer projects with management staff to ensure proper reimbursement per contracts or patient benefit
  • Participate in payer audits and collect, summarize and send requested information
  • Coordination with other finance staff for regularly scheduled reports or needed information
  • Maintain and develop software billing templates

Requirements:

  • 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.; College degree in accounting or business preferred
  • Minimum of 4 years of experience in hospital pharmacy, including experience in area of training
  • Ability to work as a team or independently in a high pace environment. Initiative, independent thinking and decision making skills are a must.
  • Experience in home infusion billing or hospital infusion center billing preferred
  • Ability to use Microsoft Office Suite products (Excel, Word, SharePoint, Access) preferred
  • Maintain compliance with University/Departmental Policies
  • Attendance: punctual and available for scheduled shifts
  • Timekeeping and overtime
  • Departmental dress code
  • Departmental cleanliness: dispensing and non-dispensing areas are kept neat and orderly

EOE Minorities/Females/Protected Veterans/Disabled

Job Title: Price Estimation and Billing Analyst

Location: Strong Memorial Hospital

Job ID: 208517

Regular/Temporary: Regular

Full/Part Time: Full-Time