As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. **Job Location (Full Address):** 601 Elmwood Ave, Rochester, New York, United States of America, 14642 **Opening:** Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500160 Pharmacy SMH Work Shift: Range: UR URG 105 H Compensation Range: $19.96 - $27.94 _The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._ **Responsibilities:** Coordinates all aspects of financial arrangements for inpatient admission of transplant patients to SMH including outpatient services rendered before and after the transplant. Coordinates claims processing and payment application and/or authorization, including physicians' bills, for all foreign transplant patients and for all special transplant contracts such as the National Bone Marrow Donor's Program, and for all demonstration projects such as the national umbrella contracts. Responsible for the patient account from preadmission until the final bill is produced. Responsibilities GENERAL PURPOSE: 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 insurance coverage determination, patient out of pocket estimation, determination of prior authorization and assembly of documentation to ensure payment for services in compliance with payer standards including Medicare and other third-party payers. Ensures proper setup of documentation to payer requirements, and works to provide information necessary to resolve denials and resolve any third-party issues. Creates and renews prior authorizations Expected to work independently and resolve and troubleshoot complex issues. RESPONSIBILITIES: PRICE ESTIMATION AND INTAKE: Act as the main contact and coordinator for incoming referrals: Retrieve and evaluate incoming Durable Medical Equipment referrals to verify insurance coverage, medical necessity of equipment being ordered and contract with payer. 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. Determine if equipment being ordered meets payer requirements for coverage. Retrieve and assemble necessary information for insurance coverage qualifications as needed Acts as liaison between home care coordinators, discharge coordinators, DME staff and providers to obtain accurate information related to coverage requirements for medical equipment. Communicate out of pocket costs to patients, caregivers or care coordinators. Develop contacts within URMC to provide accurate information based on provider or department which includes but is not limited to: Highland, Strong Memorial, URMFG, PCN, 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. Renew prior authorizations. When needed, work with UR Financial Assistance Team to communicate detailed financial information to better assist patients/families to receive proper medical care without financial burden. Coordinate delivery of equipment with various services including UR DME technicians, UR Couriers, and other commercial services. Coordinate patient resupply for consumable items such as CPAP/BiPAP Reimbursement Assessment and Information Management Reimbursement Review and Calculation of Costs Using contracted fee schedule, calculate a review of coverage and determine if coverage exists for equipment and supplies being ordered Information Maintenance Maintain monitoring system to track inquiries and new referrals BILLING DOCUMENTATION: Confirm or create delivery tickets for provided services and work collaboratively with respective service lines that are needed 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 Collect and assemble documentation needed for coverage of equipment 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 Contact patients to determine need for supplies, oxygen. Schedule patients for CPAP setups Review CPAP compliance data and contact patients to discuss any barriers for CPAP use; refer to Respiratory Therapists when needed Staff DME retail storefronts; assist patients with selection and purchase of equipment Respond to billing inquiries, resolve denials when needed QUALIFICATIONS: High School Diploma or equivalent required College degree in accounting or business preferred Minimum of 4 years of experience in related hospital credit services, including experience in area of training or equivalent combination of education and experience required Experience in home medical equipment intake and billing is preferred Ability to work as a team or independently in a high pace environment. Initiative, independent thinking and decision-making skills are a must. Ability to use Microsoft Office Suite products (Excel, Word, SharePoint, Access) preferred Maintain compliance with University/Departmental Policies RequiredAttendance: 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:** The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations. Notice: If you are a **Current** **Employee,** please **log into myURHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward. **Learn. Discover. Heal. Create.** Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better. If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals At the University of Rochester, we commit to diversity, equity, and inclusion and united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.