Full Time 40 hours Grade 009 URMFG Business Office Schedule 8:30 AM-5 PM Responsibilities Job Summary The Price Estimation Analyst will perform the functions of Patient Account Management for individuals receiving care from Strong Memorial Hospital, Highland Hospital, and/or University of Rochester Medical Faculty Group. Involves in-depth communication; collaboration; and follow-up with patients; families; third-party payers; financial case management; and utilization management. The Price Estimation Analyst will assess all aspects of providing an accurate estimation of both insurance coverage & out- of- pocket costs for all matters concerned with patient health care. The Price Estimation Analyst will have direct contact, regarding inquiries related to the cost for health care services and/or billing inquiries. The position requires a detailed understanding of medical procedures and which CPT codes and Diagnosis coding they may include/involve, broad knowledge base about medical billing, rules and regulations of third party billing. The position requires a competency level in the use of verification and third party and government billing systems. Typical Duties With general direction of the Financial Assistance Supervisor and with latitude for initiative and judgment: Incoming Inquiries and Related Information Gathering Evaluate incoming inquiries from internal and external customers from phone calls, emails and correspondence received on a daily basis. Uses comprehensive knowledge to determine and capture data.Multiple interactions may occur in order to finalize accurate price estimation. Explains and refers patients/families to the UR Medicine Financial Assistance programs offered by the University of Rochester. Explains other payment options that may be available and offered by UR Medicine. Outgoing Inquiries Related to Information Gathering and Relay of Estimate Obtains benefit information from third party payers to advise patients on their expected out of pocket costs related to deductibles, coinsurance, copayments or total charges if services are non-covered. Acts as liaison between patients and providers, including PCPâ™s, Specialists, Surgical, and Hospice to obtain accurate information, coding information, and anticipated services requiring an estimate. Develop and utilize contacts at all UR patient care locations to provide accurate information based on the provider or department which includes but not is limited to: Highland and Strong Memorial Hospitals, Wilmot and Pluta Cancer Treatment Centers, Laboratories, and Radiology. Reimbursement Review and Calculation of Costs Retrieval and dissemination of both the insurance fee schedule and insurance reimbursement matrixes. Must perform contract review and ensure that the proper reimbursement rates are utilized by determining if payments will be based on DRG, APC, fee schedule, percentage of charges, or any other defined method. Information Maintenance Completes appropriate system documentation notes in regards to the estimate provided to the patient. Provide and generate a patient estimation letter which details the anticipated costs and patient responsibility for those services quoted. Accountable for meeting departmental standards of accurate and timely financial estimation to both patients and providers within 3 business days. Maintains a monitoring system/ database to keep track of status of inquiries. Coordinate status reports to the management team. Monitoring of Data Develop audit procedures to ensure the accuracy of the information given to our customers. Complete review of estimates and services received to determine if there are any discrepancies in the rates quoted. Make recommendations to Supervisor/Management staff on how to correct these discrepancies in the future. Other duties as assigned Requirements: High school diploma and 4 years of related hospital credit services experience or Bachelor's degree in Business Administration, Health Care Administration, Psychology, or related discipline and 1 year of related experience; or equivalent combination of education and experience. Medical terminology required.
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