University of Rochester Registration and Insurance Management Specialist in Rochester, New York
Time as Reported Grade 008 Registration & Insurance Mgmt
8:30AM-5PM OR 9:30AM-6PM; OCC WKENDS
This position is a member of a Registration and Insurance Management which coordinates functions associated with Patient demographic, primary care physicians and insurance information for URMFG and SMH/HH Emergency/Outpatient departments and FFT/Noyes/Auburn Radiology. Registration and Insurance Management Specialist requires a broad knowledge base in the rules and regulations of third party billing and the complexities of multispecialty (URMFG) etc. and Facility (SMH) billing. In addition this position requires experience among the enterprise billing system; Flowcast/HBOC with a proficient competency level in the use of verification, third party and government billing systems. RIM Specialist completes the task of sending and reviewing batch file for visit volumes of 180,000 - 200,000 monthly as it relates to verification of insurance which includes but is not limited to demographic, co-pay/deductibles, benefit information, referrals/authorization, PCP information and Self Pay recovery. Responsible for contacting patient/representative regarding Insurance coverage or lack of to ensure patient is aware and secure revenue for the URMC enterprise. To pursue Medicaid for the patient the RIM Specialist initiates a referral to Financial Case Management. Responsible for updating Flowcast system edits produced by the GE batch file (GERO). This position will be responsible in part for a decrease of rework and enhance revenue of 3-5 million dollars annually. This process promotes an "uneventful" and seamless arrival process. Additionally, a RIM Specialist's advanced knowledge of insurance and system logic aids in accurate and timely reimbursement of services.
Under the direction of the RIM Operations Manager:
Responsible for pre-verification of insurance five days prior to sched appointments, real time verification (urgent care, walk ins, Emergency, etc.) for URMFG and SMH/HH Emergency/Outpatient departments and FFT/Noyes/Auburn Radiology. Remains competent with a broad knowledge base of insurance requirements and necessary changes affecting all information systems for Primary Care, hospital based practices, multi-specialty and SMH/HH Outpatient departments. Understands fiow of information between the Central Insurance Verification Unit and URMFG/SMH/HH Outpatient departments; importance of registration accuracy. Ongoing communication with management relating to operational and system issues.
Financial Account Management:
Responsible for working daily on designated edit reports generated by the GE Eligibility System based upon assignments. Initiates outgoing calls to insurance companies, patients and/or representative regarding insurance coverage or lack of in a timely and customer friendly manner utilizing Strong Commitment values. Ensures Flowcast/HBOC is updated relating to insurance, co-pay and primary care physician information prior to patient appointment and/or final bill. Completes online referrals to Financial Case Management for Self-pay patients where appropriate, follows-up with departments and primary care offices to reconcile discrepancies, investigate inaccurate insurance, primary care physician and co-pay information, provides recommendations to Lead RIM Specialist and Manager.
Third Party Payer resource to departmental staff (Access Specialist, Insurance Collection Specialists, Financial Counselor, etc.) within URMFG/SMH/HH departments. Serves as a front-line problem solver for third party billing requirements. Identifies areas of improvement, notifies Lead RIM Specialist, plan and implements as directed. Understands and adopts the Strong Commitment values and behaviors.
Continuous Learning & Compliance:
Attends and actively participates in all meetings including staff meetings, compliance and training sessions, etc. Timely completion of annual health update and mandatory hospital in-service. Understand and follows departmental policies and procedures relating to dress code, vacation/PTO requests and HRMS documentation.
Updates RIM operational procedures. Performs other related duties as assigned.
- High School Graduate and 4 years’ experience or equivalent combination of education and experience preferably in a Primary Care Office or SMH Ambulatory Care setting
- Knowledge of Verification, Third Party Payor and Government systems
- Knowledge of Flowcast
- Knowledge of PC functions (Word, Excel, e-mail, Web).
- Excellent organization and problem solving skills
- High professionalism, motivation, interpersonal skills
- Exercises excellent communication skills and customer service skills
- Ability to work in a team setting with all levels of management and staff
- Associates or Bachelor’s Degree preferred
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Registration and Insurance Management Specialist
Location: Medical Faculty Group
Job ID: 208410
Full/Part Time: TAR