Price Estimation Rep III

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.

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Schedule: 8:30 AM-5 PM

The Price Estimation Analyst will perform the functions of Patient Account Management for individuals receiving care and/or interested in receiving pricing for care from Strong Memorial Hospital, Highland Hospital, and/or University of Rochester Medical Faculty Group. Involves In-depth communication; collaboration; and follow-up with patients; families; third-party payers; financial case management; and utilization management.

Supervision and Direction Exercised:

• With general direction of the Supervisor/Manager and with latitude for Initiative and judgment The Price Estimation Analyst is responsible for self-monitoring performance on assigned tasks, following standard procedures and policies. The Price Estimation Analyst may be responsible for training other support staff.

Responsibilities:
Incoming Inquiries and Related Information Gathering

• Evaluate and process incoming Good Faith Estimates from Workqueue
• Evaluate incoming inquiries from Internal and external customers from phone calls, emails and correspondence received on a daily basis. Uses comprehensive knowledge to determine and capture data.
• Multiple Interactions may occur in order to finalize accurate price estimation.
• Explains and refers patients/families, as appropriate, to the UR Medicine Financial Assistance programs offered by the University of Rochester.
• Explains other payment options, as appropriate, that may be available and offered by UR Medicine.

Outgoing Inquiries Related to Information Gathering and Relay of Estimate

• Obtains 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 non-covered.
• Acts as liaison between patients and providers, including but not limited to: PCP's, Specialists, Surgical, and Hospice to obtain accurate information, coding information, and anticipated services requiring an estimate.
• Develop and utilize contacts at all UR patient care locations to provide accurate information based on the provider or department which Includes but not Is limited to: Highland Hospital, Strong Memorial Hospital, Wilmot and Pluta Cancer Treatment Centers, Laboratories, and Radiology.

Reimbursement Review and Calculation of Costs

• Retrieval and dissemination of both the insurance fee schedule and insurance reimbursement matrixes.
• Must perform contract review and ensure that the proper reimbursement rates are utilized by determining if payments will be based on DRG, APC, fee schedule, percentage of charges, or any other defined method.

Information Maintenance

• Completes appropriate system documentation notes in regards to the estimate provided to the patient.
• Provide and generate a patient estimation letter which details the anticipated costs and patient responsibility for those services quoted.
• Accountable for meeting departmental standards of accurate and timely financial estimation for traditional requests to both patients and providers within 3 - 5 business days.
• Accountable for meeting Public Health Service Act standards eff 1/1/2022: To provide a good faith estimate of expected charges for items and services to individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing, upon request or at the time of scheduling health care items and services. This form may be used by the health care providers to inform individuals who are not enrolled in a plan or coverage or a Federal health care program (uninsured individuals), or individuals who are enrolled but not seeking to file a claim with their plan or coverage (self-pay individuals) of the expected charges they may be billed for receiving certain health care items and services. A good faith estimate must be provided:
• Within 3 business days upon request
• Within 1 business day of scheduling an item or service to be provided in 3-9 business days
• Within 3 business days of scheduling an item or service to be provided in at least 10 business days
• Maintains a monitoring system/database to keep track of status of Inquiries.
• Coordinate status reports to the management team.

Monitoring of Data

• Develop audit procedures to ensure the accuracy of the information given to our customers.
• Complete review of estimates and services received to determine if there are any discrepancies in the rates quoted.
• Make recommendations to Supervisor/Management staff on how to correct these discrepancies in the future.
• Other duties as assigned

Requirements:

• High school diploma and 4 years of related hospital credit services experience or Bachelor's degree in Business Administration, Health care Administration, Psychology, or related discipline and 1 year of related experience; or equivalent combination of education and experience. Medical terminology required.

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.