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As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500183 Health Insurance Counseling

Work Shift:

UR - Day (United States of America)

Range:

UR URCA 206 H

Compensation Range:

$21.71 - $29.31

_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._

Responsibilities:

GENERAL PURPOSE

The individual in this position coordinates all aspects of patient financial account management for Mother and Newborn Inpatient admissions and NICU transfers. Responsible for obtaining and/or confirming newborn insurance information, legal name and pediatrician’s name. Complete the tasks of insurance verification and obtaining and/or verification of pre-certification requirements. Responsible for the follow-up on Medicaid Pending newborns and knowledge of hospital's Financial Assistance policy. Responsible for accounts from admission until the final bill is produced.

ESSENTIAL FUNCTIONS

+ Customer Interaction

+ Create a professional and effective customer-oriented environment by utilizing excellent communication skills to obtain demographic and insurance information for mother and newborn.

+ Counsel parent to ensure they are aware of steps to take and time limits to add/update coverage.

+ Assist patients and family with insurance questions and resolution of billing issues.

+ Perform as a Certified Application Counselor to assist parent with adding/updating case on NYSOH.

+ Work closely with DOH, NYSOH, and County DSS Offices to ensure auto-eligible newborns obtain insurance coverage.

+ Financial Management

+ Obtain baby legal name and troubleshoots with legal name discrepancy, DOB issues, gender mismatch, missing PCP, and incorrect effective dates for newborn and NICU cases.

+ Review each Maternity admission for insurance history by utilizing the hospital system along with RTE and third-party payer systems.

+ Obtain service-specific benefits and precertification along with all other billing requirements and track the approval process.

+ Monitor the Special Care workqueue to locate babies transferred to our NICU for notification of transfer to third party payers.

+ Notify Utilization Management of clinical requests by third party payers and requests for NICU leveling.

+ Offer ways to secure additional financial resources (e.g. applying for baby’s not on policy, limited coverage, newborn benefits, Medicaid and/or Financial Assistance) and coordination to patients/families early and often when possible.

+ Identify and confirm self-pay patients and those with financial hardship for appropriate referral to Medicaid Enrollment & Outreach for possible Medicaid application and /or Financial Assistance.

+ Maintain knowledge of third-party payer regulations and coordination of benefit rules.

+ Identify and notify patients of COBRA entitlement and assists with paperwork if necessary.

+ Quality and Case Management

+ Consistently monitor current admissions to ensure eligibility and additional clinical requirements.

+ Provide notification of admission to third party payers within 24 hours or next business day, if applicable.

+ Reconcile discharged visits to tracking spreadsheet for potential cases that may require notification to insurance companies.

+ Monitor the admission for undelivered, complications, and extended stays to notify the payers.

+ Accountable for meeting department standards for completion and QA of visits on a day to day basis by utilizing workqueues, registration checklist, and FC stop bills.

+ Monitor auto-eligible and NICU babies until added to policy.

+ Monitor High Cost babies for discrepancies, barriers, and clinical requirements.

+ Notify Provider’s office of sterilization/hysterectomy consent form for compliance if missing from EMR.

+ Compliance

+ Review Medicare for MSP questions and validations.

+ Ensure compliance with the Office of the Inspector General guidelines by notifying patients of exhausting Medicare benefits and the option to utilize lifetime reserve days.

+ Knowledge of state law requirement for length of stay of 48 hours for normal delivery or 96 hours for cesarean.

+ Ensure appropriate documentation is on file for assigned caseload.

+ Obtain all required signatures for payment of hospital services.

+ Maintain a thorough knowledge of insurance carriers’ policies and benefit levels as it relates to each admission type.

+ Interdisciplinary Processes

+ Notify Birth Certificate Office of all Medicaid and Medicaid Managed Care auto-eligible newborns.

+ Obtain and maintain NYSOH Application Counselor Certification.

+ Participate in monthly meetings with Social Work and Medicaid Enrollment & Outreach to discuss complex cases.

+ Communicates with NYSOH or DSS offices to correct auto-eligible newborn coverage discrepancies.

+ Attend educational programs for the department at the Manager's direction.

+ May train colleagues when assigned by management.

+ Other duties as assigned

MINIMUM EDUCATION & EXPERIENCE

+ High degree of professionalism and motivation required

+ Excellent written and verbal communication and customer service skills required.

+ Ability to work independently as well as in a team environment required.

+ Highly collaborative; self-starter required.

+ Strong computer skills and ability to type 45 words per minute preferred.

+ Medical terminology required preferred.

+ Flexible to work other assigned hours and/or responsibilities as needed required.

KNOWLEDGE, SKILLS AND ABILITIES

+ High degree of professionalism and motivation. REQUIRED

+ Excellent written and verbal communication and customer service skills. REQUIRED

+ Ability to work independently as well as in a team environment. REQUIRED

+ Highly collaborative; self-starter. REQUIRED

+ Strong computer skills and ability to type 45 words per minute. REQUIRED

+ Medical terminology. REQUIRED

+ Flexible to work other assigned hours and/or responsibilities as needed. REQUIRED

LICENSES AND CERTIFICATIONS

+ Certified Application Counselor (CAC) within one year required

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture 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 characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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Learn. Discover. Heal. Create.

Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.

If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals

At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.