University of Rochester Referral & Prior Auth Spec - 215898 in Rochester, New York
Referral & Prior Auth Spec
Strong Memorial Hospital
Full Time 40 hours Grade 009 Financial Counseling & Outpt Reg
The Financial Counselors assesses all aspects of patient financial account management for all visits on any urgent; emergent; preadmission; and ambulatory level. The Financial Counselors are accountable for coordinating all activities necessary to financially secure the defined case load through the verification process; requesting deposits for non-covered services and co-pays; resolving complex problems that include but not limited to precertifications; Utilization Management; coordination of benefits; baby not on policy; Cobra entitlement; Medicare Life Time Reserve days; and Medicare Advantage issues. Involves in-depth communication; collaboration; and follow-up with patients; families; third-party payers; governmental agencies; employers; social work; financial case management; and utilization management. The Financial Counselors are ultimately responsible for minimizing any delays from admission until the final bill is produced.
Creates a professional and effective customer oriented environment by utilizing excellent communication skills to obtain pertinent demographic information; confirms insurance information; discusses financial obligation; confirms with unit secretary patient agreement signature on file; documents demographic and insurance information in a timely, accurate manner in the hospital computer system following department and hospital standards.
Reviews each visit for insurance history by utilizing the hospital system along with all third party payer systems.
Obtains benefits; pre-certification requirements and/or completes notification of admissions.
Identifies and confirms self-pay patients for appropriate referral to Financial Case Management for possible Medicaid application and /or Financial Assistance.
Notifies and monitors parents for completion of paperwork when babies are not on the policy.
Notifies and monitors patients COBRA entitlement and assist with paperwork if necessary.
Identifies pre-existing conditions during the insurance verification process for lapse or creditable coverage.
Determines the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits.
Notifies Utilization Management of clinical requests by third party payers.
Maintains a monitoring system for adequate benefit coverage and eligibility throughout the inpatient stay.
Accountable for meeting department standards for completion and QA of visits on a day to day bases by making sure missing registration items are complete and authorization obtained.
Consistently monitors current admissions to ensure eligibility and additional clinical requirements.
Notifications of admission to third party payers are within the 24-48 hour guideline.
Observes discharged work queue daily for potential cases that may require notification to insurance companies.
Ensures Medicare compliance with the Office of the Inspector General guidelines by notifying patients of exhausted Medicare benefits and the option of utilizing their lifetime reserve days.
Monitors the ALC report for any level of care changes and ensure there is coverage.
Reviews Medicare for MSP questions and validation.
Checks Medicaid eligibility every 30 days for active coverage.
Attends educational programs for the department at the Manager's direction.
May train or perform other duties assigned by management.
AAS in related discipline (admitting/registration/patient billing/insurance) with 3 years of related experience, preferably in a hospital setting, or an equivalent combination of education and experience. Require high degree of professionalism and motivation with excellent communication and customer service skills; strong computer skills and ability to type 25 words per minute. Prefer medical terminology. Flexible to work weekends, other assigned hours and/or responsibilities as needed.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled