Job description

Company Description

University of Maryland Upper Chesapeake Health (UM UCH) offers the residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience.
A community-based, integrated, non-profit health system, our vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We are dedicated to maintaining and improving the health of the people in our community through an integrated health delivery system that provides high quality care to all. Our commitment to service excellence is evident through a broad range of health care services, technologies and facilities. We work collaboratively with our community and other health organizations to serve as a resource for health promotion and education.
Today, UM UCH is the leading health care system and second largest private employer in Harford County. Our 3,500 team members and over 650 medical staff physicians serve residents of Harford County, eastern Baltimore County, and western Cecil County.

University of Maryland Upper Chesapeake Health owns and operates:
University of Maryland Harford Memorial Hospital (UM HMH), Havre de Grace, MD
University of Maryland Upper Chesapeake Medical Center (UM UCMC), Bel Air, MD
The Upper Chesapeake Health Foundation, Bel Air, MD
The Patricia D. and M. Scot Kaufman Cancer Center, Bel Air, MD
The Senator Bob Hooper House, Forest Hill, MD

Job Description

The Verification/Authorization Coordinator is responsible for insurance verification processes of confirming patient eligibility, coordinating medical benefits, gaining approval for planned procedures/services and determining patient coverage / responsibility for the services to be provided. The Verification/Authorization Coordinator works with office staff to ensure that all patient information remains confidential, accurate, and exhibits excellent customer service to all patients who visit the office.

1. Responsible for insurance verification process of verifying patient eligibility, coordinating medical benefits, Contacts insurance companies to obtain benefits for possible services related to patient’s diagnosis. Informs patients, providers, and staff of benefits as appropriate. Completes accurate and thorough documentation of all benefit-related matters in EHR. Daily review of infusion schedules at Bel Air and Aberdeen to ensure all upcoming appt’s have been approved.

2. Obtains authorizations for outpatient chemotherapy (injectable, infusible and oral medications), radiology exams, genetic testing, hospital direct admissions, and other services as needed in a timely manner
3. Monitors changes in Medicare and insurance guidelines to ensure compliance. Assists with process updates. Attends training sessions via webinar and UM UCH offerings as appropriate. Provides updates to all levels of staff as appropriate. Maintains insurance-related office forms.

4. Provides relevant clinical information to insurance companies as needed. Completes accurate and thorough documentation of all authorization-related matters in EHR.

5. Identifies patients who may benefit from programs designed to assist with out of pocket expense due to high cost care and limited insurance coverage. Works closely with the Patient Financial Advocate and patients to enroll in financial assistance programs including but not limited to pharmaceutical assistance programs, copay programs, DHMH grants, private foundation grants, etc. as appropriate.

6. Identifies areas of financial exposure for the organization based on changes in Medicare or other payor guidelines. Collaborates with Director of Finance in monitoring and assisting patients with high self-pay balances.

7. Works closely with providers to overturn denials. Schedules peer to peer reviews as needed for insurance denials.
8. Files appeals process for insurance denials and provides written communication and appropriate documents to overturn claim.
9. Assist in enrollment, and resources for co – pay assistance for all oral medications.
10. Participates in Revenue Cycle, Uncompensated Care, and related meetings to address insurance denials and trends as requested.

11. Coordinates with the physicians, nurses, medical assistants and the front office team to keep the office processes functioning smoothly. Identifies and solves problems appropriately through strong initiative and proactive means.

12. Performs other duties, as assigned.

Qualifications

Qualifications: Education & Training: High school diploma or GED required. Work Orientation & Experience: Minimum of three (3) years’ experience within this field or related field such as medical coding, financial counseling setting, medical office or similar service profession. Previous oncology background, medical office and EMR experience preferred. Must be proficient with using a computer, online websites, basic medical terminology.

Additional Information

All your information will be kept confidential according to EEO guidelines.

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