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Rochester Regional Health · 12 hours ago

Financial Case Manager Lead

Rochester, NY

Full-time

Onsite

Mid, Senior Level

$26.75/hr - $29.50/hr

2+ years exp

Rochester Regional Health is seeking a Lead Financial Case Manager to support determining eligibility for Medicaid and other government health insurances. The role involves leading a team, developing patient needs-based plans, coordinating services, and participating in discharge planning.

Health CareHospitalMedicalPrimary and Urgent CareWellness

Responsibilities

Leads a Financial Case Manager team members in doing the equivalent work, assigns work to others and provides oversight, provides input to supervisor regarding team members’ performance and /or need for disciplinary actions; performs most complex tasks or procedures; serves as a resource to others in the resolution of complex issues, patient cases or technical skills

Provide team members with necessary tools and training for Maximum understanding of job responsibilities

Provide retraining and coaching team members as needed

Initiate quality review of case notes and applications of team members

Ensure self-pay patients are being met with by a Financial Case Manager

Participate in brainstorming sessions for problem solving difficult cases with team members

Support the department’s efforts in the development of the Financial Case Manager’s team, processes and reports to ensure

Participate in any work group, committee or task force as needed to ensure the accurate timely

Assess under and uninsured patient and families for community, urgent and chronic care health care coverage and payer opportunities

This may include NYS/ other state, federal entitlement programs, and community –based programs

Review self-pay census to identify under and uninsured

Receives referrals from community agencies and internal health care team members

Initiates contacts with patient/family/representative to assess necessary assistance and prioritization of needs

Maintains reports, provide necessary documents and data by deadlines and upon request of supervision

Documentation according to policies and procedures, and in the patient medical record for all patients

Understanding of the verification process through insurance websites, and basic understanding of PFS billing process

Implements effective plan to facilitate eligibility determination

Obtain RGHS release of information, completion of Medicaid application, necessary Department of Social Services forms; explain Medicaid and FINA processes, and follow-up needs

Attends appointments at DSS and or other agencies with/or to represent patients as appropriate

Assist and facilitate in obtaining necessary Medicaid or health program eligibility documents

Upholds HIPPA and RGHS policies and procedures throughout process

Completes clear action plans, prioritization of case load to move each case to closure

Serves as liaison between patient and families, RGHS Patient Financial Services, RGHS Affiliates, and community agencies

Collaborate effectively with interdisciplinary teams

Maintains confidentiality throughout case management process

Participates in Hospital, affiliate and departmental committees where appropriate

Voluntarily participates in RGHS activities and department sub teams

Participates in regular exchanges of information and presentations among Financial Case Managers, RRH team members and community agencies when appropriate

Provides input and potential resolution to supervisor on policies and/or procedures. Collaborate with relative local community-based organizations, health care agencies, state, county and local government offices informing them of available services that benefit their constituencies

Stays current with local, state and federal changes that relate to Medicaid and health care access and reimbursement

Submits required ideas for improvements via RGHS JDI’s and DIGs

Assist in the training and assimilation of new team members during orientation and throughout their probationary period

Educates patients and RGH team members on job roles, processes and programs as appropriate

Demonstrates an understanding of the diversity and culture of the various populations served

Cross training with other departmental team members to enhance knowledge and skill base and to foster team building and cross coverage as necessary

Maintains leadership standards, participates in peer interview to hire quality team members

Qualification

Medicaid knowledgeLeadership skillsBilingualDiverse populations experienceBasic computer skills

Required

An equivalent combination of work experience/education/certificates will be considered

Knowledgeable about a variety of health programs (Medicaid, federal, state, local and grant-funded)

Demonstrated experience working with diverse populations

Basic computer skills and programs proficiency

Maintain a valid NYS license for transportation to meetings/appointments

BA/BS in related field with 2 years' experience, or AAS in related field with four years' experience, or an equivalent combination of work experience and education and certificates will be considered

Maintain a valid NYS license for transportation to meetings/appointments

If working with Presumptive Eligibility programs, specific program certification will be required

NYS DL - valid New York State Driver's License - New York State Department of Motor Vehicles (NYSDMV)

Preferred

Bilingual preferred

Demonstrate leadership skills

Knowledgeable of a variety of health programs from Medicaid, federal, state, local and grant-funded programs; their regulations, processes and financial eligibility qualifications