Review patient benefit level in order to determine cost share out of pocket expense for upcoming clinic, injection, and procedure services for cancer patients.
Obtain clinic authorizations for multidisciplinary clinics which can include several departments.
Review and follow up New Patient Tracking WQ, including updating insurance status.
Communicate with patients their cost share expectations and collect pre-payment for services.
Verify and update patient demographic and insurance information as needed.
Advice alternative payment options when needed.
Provide counseling for patients without insurance coverage on ACA enrollment, Medicaid and M-Support screening.
Provide Insurance Verification for coverage changes.
Notify clinic staff of patient out of pocket cost for front end collection efforts.
Monitor, interpret and advise management regarding changes to third party payer system discrepancies, activities and trends.
Contact appropriate third party representatives for information and assistance with determining benefit level when online resources are not available.
Resolve complex insurance issues, resolve problems with payers prior to service.
Obtain prescription authorizations including pharmacies outside UM Health System.
Coordinate oral chemotherapy with specialty pharmacies.
Obtain outside UM Health System radiology authorizations.
Reconcile all charges, reviewing deletions and WQ issues.
Make appropriate PB/HB charge corrections as needed.
Diagnosis review (ICD-10) for all clinic injections, including Local Coverage Determination, National Comprehensive Cancer Network Compendium, contact providers for non-covered diagnosis and discuss options, including contacting payer for Medical Director review.
Review claims denials, including requesting medical review. Contact providers as needed for additional medical documentation.
Review physician extender services for shared, directed and independent visits.
Assist in training new employees.
Attend applicable training initiatives which include but are not limited to registration sessions, third party seminars, and in-house training.
Incorporate and practice Lean principles into daily work.
Function as a collaborative and contributing team member.
Demonstrate outstanding customer service skills.
High school diploma or equivalent combination of education and experience.
Proficiency in use of computers and software, including Microsoft Office products
Demonstrated excellent verbal and written interpersonal skills.
Demonstrated ability to multitask and produce high-quality work in a timely, accurate and efficient manner.
Demonstrated experience efficiently, professionally and handling patient confidentiality.
Demonstrated outstanding customer service skills.
Demonstrated excellent attendance record.
Demonstrated ability to work independently.
Knowledge of University of Michigan and UMHS policies, procedures and as well as regulatory requirements.
Experience with UMHS systems including MiChart, Outlook, Webdenis, as well as other payer websites.
Progressive billing experience within 5 years.
Experience with authorizations and diagnosis coding.
At least three years of progressively complex registration or billing & third party payer experience.
Monday through Friday, Hours TBD Location: KMS
University of Michigan Health System conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
The University of Michigan Health System improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 182908
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.