Commission Insurance Case Manager Jobs in Rochester, NY

Financial Case Manager

Villa of Hope helps youth and families rebuild relationships, recover from trauma and renew Hope for their future.

JOB TITLE: Financial Case Manager (Part Time)

DEPARTMENT/PROGRAM: Finance*

*Supporting Programs as Assigned (IOS Clinic, SUD Clinic, CFTSS, LHTC, New LIFE House, Tuckahoe)

SUPERVISOR: Director of Finance

FSLA: Non-Exempt

SALARY RANGE: $20-$28/hour (commensurate with education, certification, and experience)

The Financial Case Manager works with a cross functional team to plan, develop and direct our financial case management program activities associated with counseling, guiding, advising and providing outreach services to patients in need of public benefits, including Medicaid, Child Health Plus, NYS Marketplace Exchange or other public benefits.

• Exercising in-depth knowledge and understanding of public benefit programs, the Financial Case Manager’s primary responsibilities include: benefit management, referral coordination, problem resolution, monitoring caseload, documentation and reports.
• Serve as an advocate for youth and families to ensure third-party insurance eligibility and entitlements.
• Assist clients with out of pocket financial hardship apply for payment arrangements, sliding scale fees.
• Ensure collection of copay/co-insurance payments, review monthly client invoices, and monitor accounts flagged for collections. Manage collections process for programs served.
• Screen financial status of clients to determine eligibility for health insurance.
• Assist clients/families in applying for health insurance via NYS Marketplace for Affordable Health Care.
• Obtain and update prior authorization from 3rd party insurance companies.
• Navigate Monroe County ARES system and complete tracking as required.
• Complete Insurance Eligibility Verification.
• Billing Responsibilities:

• Claim Submission:

• Handle claim submissions for both outpatient and inpatient programs as assigned.

• Error Report Management:

• Review and correct error reports for each program.

• Resolve issues when possible and escalate unresolved issues to the Program Manager or Director with appropriate documentation.

• Millin Issue Tracker Oversight:

• Monitor and manage the Millin Issue Tracker for the assigned program.

• Contact patients if discrepancies or incorrect information exist in the Villa of Hope

billing system.

• Statement Creation & Payment Plan Follow-Up:

• Create client statements by program.

• Follow up with clients regarding payment plans and document all communications and changes on client accounts.

• County Insurance Setup:

• Reach out to county representatives if insurance data is missing or incorrectly entered into the system.

• Work collaboratively to ensure accurate client records.

• Run and distribute service error reports and work with staff to correct billing errors.

• Work closely with the finance department to ensure consistent agency wide policies and procedures are in place.
• Work with the Billing team to help resolve denials and authorizations.
• Exercises full compliance with the Agency’s Code of Conduct, all Agency Policies

and Procedures.

• Maintain confidentiality and security for all client and staff related materials and/or records.

• Communicate/case conference with additional agencies involved with client care.
• Act as a liaison with entities as needed and assist Behavioral Health staff in coordinating outpatient services for clients.
• Must be able to adapt to a continually evolving environment and thrive in an autonomous and deadline-oriented workplace while carrying out all job responsibilities with fidelity and accountability to the Agency’s Mission, Vision, Values, Guiding Principles and Strategic Plan.
• Ensure compliance with all State, Federal, County and accrediting bodies.
• Demonstrates, promotes and practices diversity, equity, inclusion and belonging in relation to clients and staff through respect and understanding achieved through training, individual supervision and Agency cultural activities.

Leading Self

• Character and Courage (Integrity and Trust) Leading Others
• Customer Focus Leading the Organization
• Commitment to Diversity, Inclusion, Justice and Equity

MINIMUM QUALIFICATIONS:

Bachelor’s Degree in Human Services field or Business Administration preferred or 1-2 years relevant in Behavioral Health services financial case management experience and/or serving as a Medicaid Eligibility Examiner. Certified Application Counselor credentialing preferred (successful completion within 2 months of hire). Bilingual in Spanish is a plus.

• Requires a high degree of professionalism.
• Specialized knowledge of public benefits rules and regulations preferred.
• Must be motivated with excellent interpersonal and communication skills.
• Ability to organize.
• Possess customer service skills.
• Proficient Microsoft Office.
• Ability to work in team and collaboratively with colleagues to achieve goals.
• Ability to manage conflicting priorities.
• Comprehensive knowledge of County and State Social Service System
• Eager and motivated to learn

Work is performed primarily in a standard office environment. Work entails continuous use of verbal and written communication, customer contact and ability to manage multiple concurrent tasks. Work frequently involves confidentiality, reasoning, and detail. Work involves working alone, as well as working closely with others. Approximately 75% of time is spent sitting and viewing a computer monitor. Walking to and from on-site locations. May travel between Villa work sites.