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Patient Financial Coordinator

2 months ago

Glen Burnie, Maryland, United States University of Maryland Medical System Full time
Job Overview

Company Overview:
The University of Maryland Medical System is dedicated to providing exceptional healthcare services to our community. Recognized as a leading healthcare provider, we pride ourselves on our commitment to quality, innovation, and compassionate care.

Position Summary:
Under general supervision, the Patient Financial Coordinator is responsible for managing the financial and insurance clearance processes for both scheduled and unscheduled patient appointments. This includes validating insurance coverage, handling pre-certifications, prior authorizations, and ensuring efficient scheduling and pre-registration.

Key Responsibilities:

  1. Manage the administrative and financial aspects of patient financial clearance, including insurance validation, medical necessity checks, and pre-certification processes.
  2. Initiate and monitor referrals, insurance verifications, and authorizations for all patient encounters.
  3. Utilize various payer resources and tools to gather eligibility and benefit information, including copays and deductibles.
  4. Collaborate with physician office staff to obtain necessary clinical data for authorization requests.
  5. Input and submit authorization requests to insurance carriers, providing required clinical documentation.
  6. Identify and resolve issues related to referrals and insurance verification, recommending process improvements as needed.
  7. Follow up on pending authorization requests to ensure timely processing.
  8. Coordinate and schedule patient services with healthcare providers and clinics.
  9. Investigate service delays and discrepancies in orders.
  10. Assist management in addressing denial issues by providing relevant data.
  11. Pre-register patients to collect demographic and insurance information for billing and verification purposes.
  12. Maintain effective communication and rapport with inter-departmental personnel, including ancillary departments and financial services.
  13. Support Medicare patients with the Lifetime Reserve process as applicable.
  14. Review admissions from the previous day to ensure proper payer notification.
  15. Travel between facilities as required.
  16. Perform additional duties as assigned.

Qualifications:

  1. High School Diploma or equivalent is required.
  2. A minimum of 2 years of experience in healthcare revenue cycle, medical office, or patient access is preferred.
  3. Experience with healthcare registration, scheduling, and insurance processes is advantageous.

Skills and Competencies:

  1. Familiarity with medical and insurance terminology.
  2. Understanding of various medical insurance plans, particularly managed care.
  3. Ability to effectively resolve customer service issues.
  4. Strong verbal communication and interpersonal skills to engage with patients and healthcare teams.
  5. Analytical skills to address problems and assist patients with financial clearance.
  6. Basic knowledge of UB04 and Explanation of Benefits (EOB).
  7. Some understanding of medical terminology and coding practices.
  8. Demonstrated dependability and problem-solving abilities.
  9. Knowledge of hospital administrative practices and regulations is preferred.
  10. Familiarity with Epic systems is a plus.

All information will be kept confidential in accordance with EEO guidelines.