Patient Reimbursement Coordinator

Position Summary:

This position performs initial patient financial and insurance verification and follow-up. Serves as communication liaison between team members, third party payers, patients, and billing for all financial arrangements. Works closely with referral sources and patients regarding their financial responsibilities. Is also responsible for document management of patient information and ensuring that the claims produced for billing are accurate.

This position offers the option to work remotely after completion of onsite training, candidates must live within a 2-hour driving distance from our Middleton, WI location. We have a competitive benefit package including excellent PTO!

Technical Responsibilities:

• Performs initial insurance verification and authorization for patient referrals in a timely and effective manner.
• Communicates effectively with referral sources regarding patient financial responsibilities and insurance coverage for nutrition services.
• Communicates with patients regarding financial responsibility both verbally and in writing.
• Performs price negotiations, when applicable, in the best interest of the patient with respect to UWHCD business (including self-pay arrangements), seeking management approval when applicable.
• Maintains knowledge of reimbursement principles and pricing parameters.
• Understands Medicare coverage principles and requirements for covered and non-covered therapies.
• Understands coverage principles and requirements for Wisconsin Medicaid.
• Understands formula and related DME and supply pricing, as it relates to enteral therapy.
• Verbally communicates patient information (including but not limited to insurance and authorization status) to team members in a timely manner.
• Promptly documents all patient information including insurance and authorization information in accordance with company policy and procedures.
• Remains up to date on contract, network, and fee schedule information.
• Obtains authorization extensions on existing patients in a timely and accurate manner.
• Performs ongoing verification of patient insurance, as needed.
• Collaborates effectively with Reimbursement to troubleshoot patient specific A/R issues.
• Performs critical evaluation of vended patient cases and keeps management apprised of any trends or issues, as applicable.
• Serves as a back-up support to the enteral POC in managing supply orders and problem-solving delivery challenges.
• Performs on-call duties as assigned.
• Other duties as assigned.