University of Washington Human Resources

UW CODE AND REPRESENTATIVE GROUP

8057 (SEIU Local 925 Clerical Nonsupervisory)

CLASS SERIES CONCEPT

Provide financial screening, counseling, and assistance to patients and verify insurance eligibility and obtain pre-authorization for coverage.

BASIC FUNCTION

Provide financial screening, counseling, and assistance to patients and their families for all funding options, including eligibility for social and/or government assistance and other financial assistance programs and plans. Verify insurance eligibility and obtain pre-authorization for coverage for both scheduled and unscheduled visits. Communicate to patients their potential financial responsibility and facilitate collection of these monies prior to date of service.

DISTINGUISHING CHARACTERISTICS

Under direct supervision, learn UW Medicine policies, procedures, forms, and processes which are necessary to perform financial counseling and/or clearance work.

TYPICAL WORK

Participate in on-the-job training to learn to:

Apply UW Medicine specific practices and understand the organization structure for appropriate use of such things as computer systems; authorization requirements; forms; unit/department-specific policies and procedures; State and Federal laws, e.g. HIPAA Compliance;

Verify eligibility and benefits for commercial, government, and third-party payors;

Validate eligibility and obtain prior authorizations for inpatient and outpatient services;

Act as a liaison with outside agencies; provide medical documentation to justify and obtain approved inpatient stays; inclusive of filling out and answering complex questionnaires based on chart notes, reports, and records;

Communicate with appropriate clinical staff the status of ongoing payer requests and the need for additional information in order to facilitate completion of all payer requirements.

Notify appropriate persons of denials and/or potential denials for non-covered services and other problems; initiate communication to appropriate agencies and to hospital staff for appeal of denials;

Conduct necessary follow up on all initiated prior authorizations at pre-determined intervals in an effort to obtain the final authorization number, i.e. insurance approval;

Using appropriate criteria, read patient chart documentation, identify and relay relevant information to justify patient care, meet agency reimbursement requirements to justify admission, treatment, and length of stay;

Research history of account upon receipt of denial and initiate steps to overturn denial when appropriate.

Use system tools to assess medical necessity of planned services and communicate to clinical staff when insurance company determines an upcoming service is not medically necessary;

Use online and internal tools to provide coding as requested to verify eligibility or aid in insurance approval and interim billing; update codes based on information from internal sources;

Estimate hospital and professional charges, calculate anticipated total charges and patient financial responsibility; communicate to patients the potential financial responsibility, necessary deposits, and facilitate collection of amounts owed;

Update patient demographic and insurance information.

Assist patients and/or patient's families in completion of complex Medical Assistance/Medicaid applications, including presumptive applications; assess medical financial assistance eligibility; submit applications to the Washington State Health Care Authority (HCA);

Advise patients and family members in accessing hospital, social, financial, and community services by consulting and making referrals to social workers, patient care coordinators, nursing liaisons, outside agencies and legal services;

Compose correspondence requesting information, verifications and documentation to support the application and for Washington State Department of Social and Health Services (DSHS) eligibility determination; continue to maintain contact with patients to assist in response to additional request from DSHS;

Obtain required verification from patient or family members and medical reports from physicians;

Manage case assignments by monitoring each phase of the application process; identify systems issues that contribute to delays in service;

Advise hospital staff regarding policies and eligibility criteria of medical assistance programs for discharge planning;

Act as information resource to physicians, other departments, health care facilities, and agencies, assess health record to assure documentation supports services provided;

Interpret chart notes/clinical information, determine appropriate information, and communicate it verbally upon authorization request with nurse reviewers and various insurance carriers;

Obtain chart notes/referral information from outside providers/clinics in order to fulfill insurance carriers criteria for authorization submission;

Coordinate with the Utilization Management department to facilitate patient admission/discharge information to fulfill insurance carrier requirements;

Advise and assist patients in the Medical Assistance/Medicaid reconsideration and fair hearing procedures;

Attend continuing education workshops and other training activities to keep up to date with current hospital practices and payer requirements;

Participate in special project work;

Learn and become proficient in the Financial Access Specialist 2 duties;

Perform related duties as required.

MINIMUM QUALIFICATIONS - UW Contract Classified

High School diploma or GED certificate plus one year of experience in a medical office setting. OR Equivalent education/experience.

CLASSIFICATION HISTORY

New classification: 10-2016