- Review patient benefit level in order to determine cost share out of pocket expense for upcoming clinic, procedure and infusions services.
- Obtain clinic authorizations for multidisciplinary clinics which can include several departments.
- Review and follow up New Patient Tracking System, 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.
- Review infusion documentation, ensuring encounters are closed.
- Responsible for 100% infusion work queue review.
- Follow up with infusion nurses and ensure correct billing documentation.
- Reconcile all charges, reviewing deletions and WQ issues.
- Diagnosis review for all infusions, including Local Coverage Determination, 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. Provide reports to Medical Director.
- 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
- At least three years of progressively complex registration or billing & third party payer 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.
Monday through Friday, 9am-5:00pm
Location: Eisenhower Place
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.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.