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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 URC 206 H

Compensation Range:

$20.99 - $28.34

_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:

Manages and provides financial account management for assigned caseload. Identifies and determines the accuracy and completeness of insurance and demographic information to ensure case is secure prior to discharge. Identifies problems, including but not limited to, pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal processes. Communicates and follows-up with assigned area, Financial Assistance, Social Work, Utilization Management, Financial Case Management, patients, families, third-party payers, and governmental agencies.

ESSENTIAL FUNCTIONS

+ Documents demographic and insurance information in a timely, accurate manner in the hospital computer system, following department and hospital standards. Assesses each account for benefits, authorizations, self-pay balances, or other concerns that may potentially result in payment or discharge issues. Monitors caseload and documents information regarding insurance and exhausted benefits for timely follow-up and referrals. Tracks patients unable to participate in insurance management due to cognitive barriers or medical intensity and ensures their or surrogate representative’s ultimate participation in the case management process. Performs ongoing case management for continuous coverage on all Medicaid, Out of State Medicaid, and Medicaid Managed Care cases for appropriate follow-up and timely referral to Financial Case Management team.

+ Develops process to monitor caseload, documents thoroughly in the hospital financial system and communicates essential information to appropriate parties in a timely and accurate manner. Identifies barriers to securing cases and develops and implements a plan to successfully resolve issues. Identifies areas and recommendations for process/operational improvement. Utilizes resources and investigational skills to solve unique and complex problems. Delegates tasks in times of absence or high work volume and provides guidance and quality assurance of work.

+ Reviews Medicare for MSP questions and validations. Ensures compliance with the Office of the Inspector General guidelines by notifying patients of exhausting Medicare benefits and the option to utilize lifetime reserve days. Ensures appropriate documentation is on file for assigned caseload. Maintains a thorough knowledge of insurance carriers’ policies and benefit levels as it relates to each specialty.

+ Assists in communication and coordination of activities with multiple areas within the University of Rochester Medical Center System. Coordinates with external parties, including patients, families, physician offices, third party payers, Department of Social Services, Department of Health, police departments, attorneys, outside hospitals, governmental agencies and external review agencies. Explains workflow and policies to areas of impact. Provides training and resources to all coverage and those within URMC/affiliates.

+ Creates a professional and effective customer-oriented environment by utilizing excellent communication skills to obtain pertinent demographic information. Confirms insurance information and discuss financial obligation.

+ Other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

+ High School diploma or equivalent and 3 years of related experience, preferably in a hospital setting required

+ Associate's degree preferred

+ Or equivalent combination of education and experience

KNOWLEDGE, SKILLS AND ABILITIES

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

+ Ability to work with a diverse population, including physically handicapped, mentally ill, drug and alcohol dependent patients and family members required

+ Excellent written and verbal communication and customer service skills required

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

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.

Notice: If you are a **Current Employee,** please **log into myURHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward.

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.