Position Summary: We have an exciting opportunity to join our team as a Business Office Associate.
In this role, the successful candidate, under minimal supervision, will have the ability to work independently. Is a patient advocate on behalf of patient and family to investigate with payers and meet with patient to educate on treatment benefits and financial responsibilities. Identifies and determines in accordance with established policies and procedures the accuracy and completeness of financial, insurance and/or demographic information for these treatment patients at the Perlmutter Cancer Center locations. Investigates and reviews the accuracy and completeness of insurance information by reviewing accounts as they appear on the Appointment Schedule and Worklist. Obtain all necessary payer requirements for obtaining Chemotherapy and Radiation Treatment referrals, authorizations and/or pre-certifications. TFC is responsible for assuring that patients have adequate insurance benefits or funding for treatment patients.
A variety of functions and responsibilities related to insurance verification and processing prior to and/or after discharge of patient, which includes:
Obtain detailed benefit information for all aspects of the treatment process including insurance verification. Obtains referrals, authorizations/precertification when applicable. Is responsible for maintaining the accuracy and continual review of current authorizations and re-authorizes as needed.
Researches and obtains all insurance plans and confirms patient benefit eligibility, including patient liabilities, clauses, riders and payers, and secondary payer information and coordination of benefits.
Acts as the patient advocate with the patient and/or family members and liaison with the insurance companies toassist in obtaining insurance information. Face-to-face interviews with patients and/or family members; advises patient with regards to next steps or processes for securing financial coverage.
Reviews and interprets insurance pre-authorization requirements. Ensures proper pre-authorizations havebeen obtained. Completes on-line operations for specific payers to complete the pre-certification process. Provides information to the appropriate HB and PB billing specialist to ensure accurate billing for current and future treatment services.
Secures documentation of insurance liability via internal and external resources. Resolves discrepancies by contacting patients, family members, and employers. Also contacts Medicare, Medicaid, Medicaid Managed Care plans, Blue Cross, and all other PPO, EPO and HMO commercial carriers pre-certification areas for updates regarding authorization screenings, and all other external agencies and patient advocates. Maintains and expands knowledge base of on-line applications used for determining eligibility for Financial and Patient Assistant programs
Determines the extent of liability for insurance plans, coordination of benefits and financial responsibility. Ability to review, analyze and act upon third party COB discrepancies prior to billing. Determines primary and/or other insurance eligibility compliance standards based on predetermined regulations.
Handles Insurance questions and/or obtains information from various Perlmutter Cancer location areas including but not limited to, physicians, patients, patient advocates, payers, and outside agencies via telephone, mail, or in person associated with treatment matters. Ability to communicate on a professional level with other departments within NYUMC. Take initiative to teach and share new information and provide constructive feedback.
Communicates financial information and payer requirements to the practice staff when a patient meets with a financial counselor on consult day, patient inquiry phone call or when identifying the patient on the Treatment DAR.
Monitoring and updating information regarding insurance data, authorizations, and re-authorizations, change of treatment authorizations including same day clearance updates. Identifies patients with non-par insurance who have been referred for OP treatment after hospital discharge .Forwards information to management to work with office of Managed Care to establish negotiate an agreement to pay before referring the patient out.
Maintains status on a daily, weekly, and monthly basis as applicable based upon course of treatment and authorization criteria for patients appearing on the DAR as scheduled. TFC is required to remain anywhere from one week at a minimum to 30 days out on their DAR as established by management and continually updating pending clearances and authorizations prior to treatment
Responsible for referring patients to par providers on their plan for non-par policies that out of network authorization and agreements are not available to us as well as communicating this information to the practice. TFC is responsible to Screen patients for Medicaid and FAP when other insurance cannot otherwise be secured. Assist patients with financial inquires. For billing inquires the TFC tries their best to answer questions an/or provide the appropriate HB and PB contact to the patient.
Performs other duties and special projects as assigned or requested Demonstrates knowledge of the organizations Service Standards and incorporates them into the performance of duties. Communicates and collaborates well with fellow staff members as well as other departments of the Perlmutter Cancer Center locations and other departments of NYULMC.
Minimum Qualifications: To qualify you must have a High School Diploma and 1 year experience in patient accounts or related field or an equivalent combination of education and experience. Strong knowledge of Front end hospital registration and /or practice operations is a must. Knowledge of insurance companies verification and benefit tools including web sites etc. Ability to compose and edit logical, detailed, comprehensive and grammatically correct correspondence. Ability to effectively communicate with a wide variety of personnel including patients, families, physicians and staff. Knowledge of medical terminology. Experience and competency with varied computer hardware and software, including registration and billing systems, word processing, spreadsheet, database, scheduling, communications. Training on appropriate systems will be provided. Ability to handle matters of highly confidential and sensitive nature. Ability to recognize and identify problems, recognize implications and propose alternative solutions. Skill in prioritizing assignments to complete work in a timely manner. Skill in working independently and in following through on assignments with minimal direction.
Preferred Qualifications: Preferred Qualifications::2-4 years of Healthcare customer service and health insurance experience. Prior EPIC experience a plus.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal 'EEO is the law' poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. To view the Pay Transparency Notice, please click here.