Registration&Insur Mgt Rep III

Rochester, NY


Job Summary

This position is a member of a Registration and Insurance Management team which coordinates functions associated with Patient demographic, Guarantor, and Insurance Coverage for UR Medicine. Registration and Insurance Management Specialist requires a broad knowledge base in the rules and regulations of third-party billing and the complexities of multispecialty billing. In addition this position requires experience among the enterprise billing system; Flowcast/EPIC with a proficient competency level in the use of verification, third party and government billing systems. RIM Specialist completes the task of sending real time eligibility and also reviewing batch file for visit volumes of approximately 300,000 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 registration, 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 Epic WQ’s. 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.

Key Functions and Expected Performances

Under the direction of the RIM Director:

Weight =45%

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 Outpatient departments. 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 flow 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: Weight = 40%

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/Epic 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 CIV Specialist and Manager.

Customer Interaction : Weight = 15%

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 CIV 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.

Other duties :

Updates RIM Unit operational procedures. Performs other related duties as assigned.

Background Expectations:

  1. Associate Degree and 2 years’ experience or equivalent combination of education and experience preferably in a Primary Care Office or SMH Ambulatory Care setting

  2. Knowledge of Verification, Third Party Payor and Government systems

  3. Knowledge of Flowcast

  4. Knowledge of PC functions (Word, Excel, e-mail, Web).

  5. Excellent organization and problem-solving skills

  6. High professionalism, motivation, interpersonal skills

  7. Exercises excellent communication skills and customer service skills

  8. Ability to work in a team setting with all levels of management and staff

  9. Associates or Bachelors Degree preferred

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: $18.65 - $26.11 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: Medical Faculty Group
Full/Part Time: Full-Time