Schedule Details:

Scheduled Hours:

Shift:

Hours:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:

1. Obtains detailed patient insurance benefit information for all aspects of the medical treatment process including, but not limited to, coverage and network requirements, outpatient prescription drugs, follow-up clinic visits, and travel and housing if necessary.
2. Reviews summary plan descriptions. Verifies specific co-pays, deductibles, out of pockets, contract maximum amounts, and outpatient pharmacy coverage for each patient.
3. As necessary, coordinates with the contracting department (who obtains the highest reimbursement for services on a case-by-case basis).
4. Manage proper course of action for maximum reimbursement of health care charges: spend-down eligibility, cobra coverage, etc.
5. Establish contact with case manager at insurer, employers and self-insured groups as needed.
6. Obtain insurance pre-certification for patients as necessary.
7. Monitors and updates patient insurance data, physicians, authorizations, preferred providers and documents in EMR with required financial guarantor notes.
8. Coordinates with physicians and other clinical staff to ensure accurate knowledge of treatment protocols and issues.
9. Coordinate and facilitate financial process for treatment services in collaboration with Contracting, Patient Accounts, Physician Billing and Reimbursement, and other departments as necessary.
10. Ensures compliance with Medicare/Medicaid regulations for treatment services.
11. Determine eligibility for government assistance programs. Calculate and assess discount percentages. Establish payment arrangements and settlements appropriately.
12. Act as a liaison between patients and insurance companies to assist in the resolution of reimbursement issues. Facilitates resolution of patient billing issues.
13. Serves as a resource for patients and their family members on financial matters.
14. Attends and participates in daily/weekly meetings as necessary. Communicates with members of the clinical team, patients, and their families in identifying any potential out-of-pocket expenses.
15. Attends seminars and courses on relevant topics, (i.e. Medicare/Medicaid, HMO's, UNOS, etc.), educating affected areas and applying updated information accordingly for complete compliance of federal regulations.

II. Position Qualifications:

License/Certification/Education:
Required:
1. Associate Degree.

Experience/Skills:
Required:
1. Minimum of 2 years financial experience in a hospital/medical related program.
2. Minimum of 2 years experience in medical insurance.
3. Demonstrates an understanding of insurance industry standards, payor payment methodologies, and managed care concepts.
4. Knowledge of insurance pre-certification and verification.
5. Knowledge of third-party regulatory guidelines.
6. Familiarity with medical terminology.
7. Excellent analytical and communication skills.
8. Knowledge of Medicare/Medicaid.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.