Price Estimation Rep III

Responsibilities

• Affirms and addresses inquiries related to the cost of health care service and/or billing inquiries.
• Evaluates and processes incoming Good Faith estimates, as well as incoming inquiries from internal and external customers from phone calls, emails, and correspondence.
• Explains and refers patients and/or families, as appropriate, to the UR Medicine Financial Assistance programs offered by the University.
• Explains other payment options that may be available and offered, as appropriate.
• 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.
• Develops and utilizes contacts at all patient care locations to provide accurate information based on the provider or department.
• Retrieves and disseminates the insurance fee schedule and insurance reimbursement matrixes.
• Performs contract reviews and ensures the proper reimbursement rates are utilized by determining if payments will be based on diagnosis-related group (DRG), Ambulatory Payment Classifications (APC), fee schedule, percentage of charges, or other defined methods.
• Completes appropriate system documentation notes regarding the estimate provided to the patient.
• Provides and generates patient estimation letter which details the anticipated cost and patient responsibility for those services quoted.
• Has accountability for meeting departmental standards for accurate and timely financial estimation for traditional requests to both patients and providers.
• Has accountability for meeting Public Health Service Act standards and providing a Good Faith estimate.
• Develops audit procedures to ensure the accuracy of the information given to customers.
• Completes reviews of estimates and services received to determine if there are any discrepancies in the rates quoted. Makes recommendations to leadership on how to correct these discrepancies in the future.

Requirements

• Bachelor's degree and 3 years of relevant experience required
• Or equivalent combination of education and experience

Qualifications

• The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture 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 characteristic protected by federal, state, or local law (Protected Characteristics).