University of Rochester Infusion Intake Pricing Analyst in Rochester, New York
Full Time 40 hours Grade 009 Pharmacy SMH
Under the supervision of the manager, responsible for insurance verification and charge estimation and assembly of needed documentation for billing to include confirmation of service provision, prior authorizations, and a detailed review of services provided to ensure that billing services have complete information necessary to create claims. The primary focus is on price estimation, assembly of documentation, to ensure payment for services in compliance with payer standards including Medicare and other third party payers Ensures proper coding of claim submissions to payer requirements, and works to provide information necessary to resolve denials and resolve any third party issues. Expected to work independently and resolve and troubleshoot complex issues.
Price Estimation and Intake
- Incoming inquiries and related information gathering and outgoing communication related to information gathering and relay of estimate
- Retrieve and evaluate incoming home infusion referrals to verify insurance coverage and contract for infusion therapy and associated nursing..
- Refer patients/families to UR Financial Assistance Team to get detailed financial information to better assist patients/families to receive proper medical care without financial burden.
- Obtain 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 not covered.
- Acts as liaison between home care coordinators, discharge coordinators, home infusion staff and providers to obtain accurate information related to coding and services for home infusion billing.
- Develop contacts within URMC to provide accurate information based on provider or department which includes but is not limited to: Highland, Strong Memorial, Offsite infusion and cancer centers, FF Thompson and other affiliate hospitals.
- Assessment and identification of specific needs for payer coverage of billed goods and services to include proper documentation, and prior authorization
- Reimbursement Review and Calculation of Costs
- Retrieval and dissemination of both the insurance fee schedule and insurance reimbursement matrixes
- Perform contract review and ensure proper reimbursement rates are utilized by determining if payments are part of home infusion per diems, drug or nursing charges.
- Information Maintenance
- Review individual payer reimbursement schedules and proactively update home infusion billing system on payer determined schedule
- Maintain monitoring system to track inquiries and new referrals
- Confirm delivery tickets for provided services and work collaboratively with respective service lines to assemble information necessary for billing
- Coordinate required information for denied claims for billing
- Participate in multidisciplinary teams for problem solving
- Accurately handle deposits as needed
- Contact manager when assistance is needed when solution is beyond expertise or authority
- Work in conjunction with pharmacy finance to ensure accounts receivable balances are accurate and payments are applied correctly
- Other Responsibilities
- Coordinate internal billing activities between departments such as charity care, social work and others as needed
- Manage special payer projects with management staff to ensure proper reimbursement per contracts or patient benefit
- Miscellaneous documentation needs as required
- Participate in payer audits and collect, summarize and send requested information
- Coordination with other finance staff for regularly scheduled reports or needed information
- Maintain and develop software billing templates
- Ability to work as a team or independently in a high pace environment. Initiative, independent thinking and decision making skills are a must.
- Minimum of 3 years of experience in hospital pharmacy or healthcare, including experience in area of training
- High School Diploma or equivalent; College degree in accounting or business preferred
- Experience in home infusion billing or hospital infusion center billing preferred
- Ability to use Microsoft Office Suite products (Excel, Word, SharePoint, Access) preferred
- Maintain compliance with University/Departmental Policies
- Attendance: punctual and available for scheduled shifts
- Timekeeping and overtime
- Departmental dress code
- Departmental cleanliness: dispensing and non-dispensing areas are kept neat and orderly
- Complies with all University/Departmental Policies and be able to access them. Understands consequences if not followed
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Infusion Intake Pricing Analyst
Location: Strong Memorial Hospital
Job ID: 211339
Full/Part Time: Full-Time