University of Utah Job Description
Job Summary
Facilitates the resolution of funding issues for insured and self-pay hospital patients. Assists patients in collecting and completing the required documents needed to obtain state, or other third-party, financial assistance. Maintains on-going communication/education with physicians, case managers/case workers, and patients, regarding the status of funding. Works with Medical Director, physicians, and billing offices to determine cost estimates for procedures and coordinates patient access to scheduled procedures.
Qualifications
Four years experience with medical accounts receivable, insurance claims, or equivalency (one year of education can be substituted for two years of related work experience); Familiarity with commercial or government billing requirements, Health Care Financing Administration (HCFA) regulations, and customer service practices and; Basic knowledge of accounting principles, word processing, spreadsheets, and demonstrated human relation and effective communication skills.
Comprehension of Medicaid eligibility guidelines and bilingual language (Spanish) skills may be preferred.
This position is patient-sensitive and must fulfill all associated vaccination requirements, or be approved for an exemption, prior to the first day of work. We protect our patients, coworkers and community by requiring all patient-sensitive employees to be immunized according to CDC standards and hospital policy. Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.
Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.
Disclaimer
This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.
Essential Functions
1. Interviews and evaluates patients to determine eligibility for assistance programs and helps complete associated forms.
2. Explains topics of insurance coverage, treatment costs, prompt pay and/or financial hardship discounts to patients and/or family members during catastrophic or challenging life events which may involve, but are not limited to, death, amputation and disability.
3. Contacts appropriate agencies to obtain information and paperwork necessary to process patients’ assistance applications. These resources can include state caseworkers, banks, Social Security Administration, employers, medical facilities, workers compensation administrators, insurance companies, and police departments.
4. Establishes and maintains a positive working relationship with patient to meet their needs, ensure process compliance, and resolve outstanding billing issues between physicians, hospitals and insurance companies.
5. Follows up with patients who do not qualify for outside assistance to determine financial hardship discount, charity write-offs and/or payment arrangements.
6. Confirms correct insurance information and coordinates efforts with various teams for correct and timely billing.
7. Acts as gate-keeper for scheduled procedures wherein patients have inadequate or no funding.
8. Coordinates Certificates of Medical Necessity, determines and collects payments due prior to procedure, and communicates ineligibility to physicians and patients when necessary.
9. Determines third-party liability in cases of injury/assault and initiates and amends hospital and attorney liens.
10. Initiates claim process with third-party payor (i.e.: auto insurance company, worker’s compensation) on behalf of patient when appropriate.
11. Schedules intake appointments for new patients and updates patient demographics and registration information as needed
Problem Solving
Incumbents have the authority to write-off costs in prompt payment discounts. They must have a comprehensive understanding of the Fair Debt Collection Practices Act, The Emergency Medical Treatment and Liability Act, Medicaid, Medicare and hospital policies and procedures to determine patient costs and eligibility for programs. Incumbents are expected to utilize discretion in determining the appropriate course of action after assessing the patient’s financial situation.
Comments
Incumbents are charged with collecting account, insurance, and demographic information in a professional and empathetic manner during situations that can be emotional and stress provoking.
Work Environment and Level of Frequency that may be required:
Nearly Continuously: Office environment.
Seldom: Infectious disease, oils (there is air or skin exposure to oils or other cutting fluids).
Physical Requirements and Level of Frequency that may be required
Nearly Continuously: Hearing, listening, talking.
Often: Repetitive hand motion (such as typing), walking, standing, sitting.
Seldom: Bending, reaching overhead.
The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit. The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.
