We have an exciting opportunity to join our team as a Financial Counselor.
In this role, the successful candidate is a patient advocate on behalf of patient and family to investigate with payer and meet with patient to educate on transplant benefits and personal responsibilities. Identifies and determines in accordance with established policies and procedures the accuracy and completeness of financial, insurance and/or demographic information for inpatient transplant admissions at NYU Medical Center. Investigates and reviews the accuracy and completeness of insurance information upon pre-admission and/or admission to ensure account is secure prior to discharge. Obtain all necessary payer requirements including but not limited to referrals, pre-certification, and case management.TFC is responsible for assuring that there are adequate insurance benefits or funding for transplant 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 transplant process, including Pharmacy, inpatient, outpatient care, transplant coverage. Verifies and obtains precertification coverage for all inpatient stays and outpatient procedures
Researches and obtains all insurance plans and confirms patient benefit eligibility, including patient liabilities, clauses, riders and payers, and secondary payer information (coordination of benefits).
Acts as the patient advocate with the patient and/or family members and liaison with the insurance companies to assist 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 group pre-certification requirements. Ensures proper pre-authorizations have been obtained. Completes on-line operations for specific payers to complete the pre-certification process. Communicates data to NYUMC Utilization Management Department to continue medical review process. Provides information to the appropriate billing specialist to ensure accurate billing for current and future services.
Secures documentation of insurance liability via internal and external resources. Resolves discrepancies by contacting patients, family members, and employers. Also contacts Medicare. Medicaid P.A.C.R. requirements area, Utilization Management, Medicaid and employer group HMOs, Workmens Compensation, Blue Cross pre-certification area for updates for authorization screens, and all other external agencies and patient advocates. Maintains and expands knowledge base of on-line applications used for determining eligibility.
Determines the extent of liability for insurance plans, coordinates of benefits and personal 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 NYUMC areas including but not limited to clinics, physicians, and patients, attorneys, employers, payers, and outside agencies via telephone, mail, or in person associated with transplant 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.
Obtains referral from Primary Care Physicians prior to admission for managed care plans. Communicates financial information and payer requirements to the Transplant Team both at the time of evaluation and at the time of listing. Prepare patients folders for weekly listing meeting
Monitoring and updating information regarding insurance data, physicians, authorizations, and preferred providers. Assisting patients with questions concerning insurance and other financial issues. Identifies patients with inadequate coverage or non-par agreements and forwards the information to the administrator, medical director and transplant coordinator. Supervisor and the Office of Managed Care work together to establish one time agreements.
Maintains status on a daily, weekly, and monthly basis of all wait listed patients pending verification reviews, and takes appropriate action to resolves accounts. Performs other related duties and special projects as assigned or requested. Contributes to on-going work flow enhancements. Assists in the transfer and pre-admission of patients as well as verifying and obtain precertification
Responsible for referring accounts to the Medicaid Liaison when other insurance can not otherwise be secured. Assist patients in patients in selecting and applying for Medicaid and other HMO plans. Patient contact for all inpatient, living donor and transplant billing issues. Coordinate process for donor workup (benefits, authorizations and donor benefits). 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 institution.
To qualify you must have a Bachelor's Degree in a related field. Evidence of good interpersonal skills, effective communication skills and creative problem solving. Extended knowledge base of payer and billing requirements. Improved comprehension of criteria needed for multiple payers. Ability to analyze and update accounts via electronic hospital and medical systems, according to specific standards and guidelines and sustain a knowledge base applicable to on going changes within the insurance realm.Assists in location of resources or assistance programs for which uninsured patients may be eligible
4 years of Healthcare customer service and health insurance experience.
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 or 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.
NYU Langone Medical Center, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of... only five hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.NYULMC.org.