Sr Bill Clk/Pat Acct Rep Hlth

Michigan Medicine; Ann Arbor (MI); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Michigan Medicine seeks a detail-oriented Billing Specialist to handle financial clearance for adult/pediatric infusion services. You will verify insurance, obtain authorizations, and collect pre-payments, working with patient financial counselors and clinic staff to ensure accurate billing and smooth patient experiences.

Role requires at least two years in complex billing, strong communication, and the ability to multitask while safeguarding patient confidentiality.

Qualifications

• High school diploma or equivalent required.
• At least two years of progressively complex billing & third-party payer experience.
• Proficiency with computers and Microsoft Office products.
• Excellent verbal and written interpersonal skills.
• Ability to multitask, work independently and maintain confidentiality.

Responsibilities

• Review patient benefit levels to determine cost share and out-of-pocket expenses for upcoming infusions services.
• Obtain authorizations or pre-determinations for all infusion services.
• Coordinate with Patient Financial Counseling, communicate cost share expectations, and collect pre-payments.
• Verify patient demographics and insurance information; collaborate with Registration for changes.
• Provide Insurance Verification for coverage changes and notify clinic staff of patient costs.
• Monitor payer system discrepancies, trends, and provide reports to management.
• Obtain and schedule medications from third-party pharmacies as needed.
• Review infusion documentation and ensure correct billing entries and queues.
• Handle claims denials, request medical reviews, and discuss options with providers.

Skills

Billing experience

Customer service

Multitasking

Independent work

Education

High school diploma

Tools

MiChart

Outlook

Webdenis

Job description

Mission Statement

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Job Summary

The Infusion Core Business Team is a Michigan Medicine Ambulatory Care Team dedicated to providing a high quality & comprehensive Financial Clearance for all Adult/Pediatric Cancer & Non-Cancer Infusion Services. The Infusion Core Business Team is also dedicated to handle complex scheduling for all Adult/Pediatric Non-Cancer infusion services. We are actively seeking a compassionate, enthusiastic, and patient-focused individual who will share in the goal of crafting the ideal experience for our patients, families and employees.

Responsibilities

• Review patient benefit level to determine cost share out of pocket expense for upcoming infusions services.
• Obtain necessary authorizations or pre-determinations for all infusion services.
• Collaborating with Patient Financial Counseling, communicate with patients their cost share expectations and collect pre-payment for services, including alternative payment options. Also providing counseling for patients without insurance coverage on ACA enrollment, Medicaid and M-Support screening.
• Verify patient demographic and insurance information, collaborating with Registration for changes, when needed.
• Provide Insurance Verification for coverage changes.
• Notify clinic staff of patient out of pocket cost for front end collection efforts.
• Monitor, interpret and advise management regarding changes to third-party payer system discrepancies, activities and trends.
• Contact appropriate third-party representatives for information and assistance with determining benefit level when online resources are not available.
• Resolve complex insurance issues, resolve problems with payers prior to service.
• Obtain authorization and schedule delivery of medication required to come from a Non- Michigan Medicine Specialty Pharmacy. Including ordering and follow up to ensure drug has arrived prior to service.
• Obtain prescription authorizations including pharmacies outside UM Health System
• Review infusion documentation, ensuring encounters are closed. Responsible for 100% infusion work queue review.
• Review and complete accounts that populate to Billing, High dollar, authorization, denial and scheduling WQ's.
• Follow up with infusion nurses and ensure correct billing documentation.
• Reconcile all charges, reviewing deletions and WQ issues.
• Make appropriate PB/HB charge corrections as needed.
• Diagnosis review (ICD-10) for all infusions, including but not limited to CMS, Local Coverage Determination, National Comprehensive Cancer Network Compendium, contact providers for non-covered diagnosis and discuss options, including contacting payer for Medical Director review.
• Review claims denials, including requesting medical review. Contact providers and/or PharmD as needed for additional medical documentation.
• Review physician extender services for shared, directed and independent visits. Provide reports to Medical Director.
• Assist in training new employees.
• Work with colleagues to cross-cover when appropriate.
• Attend applicable training initiatives which include but are not limited to registration sessions, third party seminars, and in-house training.
• Incorporate and practice Lean principles into daily work.
• Function as a collaborative and contributing team member.
• Demonstrate outstanding customer service skills.

Required Qualifications

• High school diploma or equivalent combination of education and experience.
• At least two years of progressively complex billing & third-party payer experience.
• Proficiency in use of computers and software, including Microsoft Office products.
• Demonstrated excellent verbal and written interpersonal skills.
• Demonstrated ability to multitask and produce high-quality work in a timely, accurate and efficient manner.
• Demonstrated experience efficiently, professionally and handling patient confidentiality.
• Demonstrated outstanding customer service skills.
• Demonstrated excellent attendance record.
• Demonstrated ability to work independently.

Desired Qualifications

• Knowledge of University of Michigan and UMHS policies, procedures and as well as regulatory requirements.
• Experience with UMHS systems including MiChart, Outlook, Webdenis, as well as other payer websites.
• Progressive billing experience within 5 years.
• Experience with authorizations and diagnosis coding.

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world?s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

• Excellent medical, dental and vision coverage effective on your very first day
• 2:1 Match on retirement savings

Modes of Work

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO Statement

The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.