Responsibilities*
Primary Responsibilities
- Verify patient insurance eligibility and active coverage.
- Verify CPT code coverage under insurance plans and applicable fee schedules.
- Identify annual, frequency, and quantity limitations associated with insurance benefits.
- Perform insurance benefit checks for hearing aids, cochlear implant upgrades and replacements, and surgical procedures.
- Document insurance benefit verification findings accurately in appropriate systems.
- Coordinate and process prior authorizations for services that fall outside the scope of the Central Authorization team, including communicating with insurance carriers and clinical staff to obtain required information.
- Manage MyHPV authorization requests through the designated workqueue, including monitoring authorization status, completing necessary follow-up, and communicating with patients and clinical staff regarding authorization requirements and outcomes.
- Prepare, explain, and process Advance Beneficiary Notices of Noncoverage (ABNs) and applicable patient financial responsibility waivers in accordance with payer requirements and established departmental procedures.
- Communicate insurance coverage findings, benefit limitations, potential out-of-pocket expenses, and financial responsibility to patients and clinic staff.
- Coordinate with patients and clinic staff to obtain required acknowledgments, completed waivers, and supporting documentation prior to scheduled services, when applicable.
- Review, track, and coordinate Speech-Language Pathology (SLP), Audiology, and Vestibular service orders to ensure required documentation is complete and appropriate follow-up is completed.
- Monitor and manage therapy plans of care, including tracking outstanding documentation, obtaining required signatures, and coordinating renewals and updates with clinical staff.
- Collaborate with Revenue Cycle Analysts, providers, and clinical staff to address insurance coverage questions, authorization requirements, and documentation discrepancies.
- Identify and escalate complex insurance coverage issues according to established workflows.
- Assist with developing and maintaining standardized benefit verification, authorization, and order management processes to support timely patient care.
Additional Responsibilities:
- Responsibilities may include additional benefit verification, authorization coordination, order management, and therapy plan activities as assigned, based on departmental operational needs and established job classifications.
Required Qualifications*
Graduation from high school or an equivalent combination of education and experience.
Minimum 3 years of experience
Desired Qualifications*
3 or more years of customer service experience within a medical environment
1-2 years of experience in patient services, medical insurance benefit verification and authorization process
Experience supporting Audiology, SLP, PT or related clinical departments
Familiarity with Michigan Medicine payer requirements and ABN processes
Ability to manage multiple complex workflows simultaneously
Why Join Michigan Medicine?
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world?s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
What Benefits can you Look Forward to?
- Excellent medical, dental and vision coverage effective on your very first day
- 2:1 Match on retirement savings
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.
Union Affiliation
This position is covered under the collective bargaining agreement between the U-M and the Service Employees International Union (SEIU), which contains and settles all matters with respect to wages, benefits, hours, and other terms and conditions of employment.
Application Deadline
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled any time after the minimum posting period has ended.
U-M EEO Statement
The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.