REMOTE Financial Clearance II

Trinity Health•Livonia, MI

10d•$18 - $27•Remote

About The Position

Responsible for ensuring all pre-service accounts are financially cleared and secured prior to the date of service for Trinity Health. Responsible for complex, high dollar services including surgical, observation and in-house services. Performs work in the multiple areas of verification: Outpatient verification, Elective Short Procedure/Inpatient verification, Urgent Admission verification or Scheduling and is responsible for obtaining and verifying accurate insurance information, benefit validation, authorization, and preservice collections. This is a key position that begins the overall patient experience and initiates the billing process for any services provided by the hospital. As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

Requirements

High School Diploma or equivalent combination of education and experience.
Must possess a comprehensive knowledge of financial clearance and insurance verification processes with three (3) years of financial clearance experience in an acute care setting.
Experienced in processing financial clearance for complex services including surgical services, observation, and in-house cases.
Strong knowledge in third-party and government payer billing and reimbursement guidelines as well as department performance standards and policies and procedures.
National certification in HFMA CRCR and/or NAHAM CHAA within one (1) year of hire.
Ability to communicate and work with patients, physicians, physician office personnel, associates, multiple direct patient care providers and others in order to expedite the registration/intake process.
Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems.
Must be proficient in the use of Microsoft Office business software
Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Must possess the ability to comply with Trinity Health policies and procedures.

Nice To Haves

Superior customer service skills and etiquette is strongly preferred.

Responsibilities

Responsible for financially clearing patients for each visit type, admit type and area of service via current HIS (Health Information System).
Collects and documents all required demographic and financial information.
Activates registration and discharges in an appropriate and timely fashion.
Coordinates with Care Management for level of care, Medicare Inpatient Only list, and required authorizations.
Coordinates with OR Scheduling on date of service changes and/or other revisions or cancellations and processes accordingly.
Analyzes patient insurance(s), identifies the correct insurance plan, selects appropriately from HIS insurance and plan selections and documents correct insurance order.
Applies recurring visit processing according to protocol.
Verifies patient information with third party payers.
Collects insurance referrals and documents within HIS.
Communicates with patients and physician/offices regarding authorization/referral requirements.
Identifies potential need for financial responsibility forms or completed electronic forms with patients as necessary.
Escalates accounts appropriately in accordance with department Defer/Delay policy to manager.
Screens outpatient visits for medical necessity and issues Advanced Beneficiary Notice as appropriate for Medicare primary outpatients.
Provides cost estimates.
Collects and documents Medicare Secondary Payer Questionnaire (MSPQ) and obtains information from the patient if third party payers need to be billed (i.e., worker's compensation, motor vehicle accidents and any other applicable payer).
Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans.
Ensures Meaningful Use requirements are met as appropriate.
Screens all patients self-pay & out of network patients using approved technology.
Provides information for follow up and referral to the RHM Medicaid Vendor and/or Financial Counselor as appropriate.
Initiates payment plans and obtains payment.
Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family.
Incorporates point of service (POS) collection processes into daily functions.
May issue receipts and complete cash balance sheets in specified areas where appropriate.
Utilizes audits and controls to manage cash accurately and safely.
Maintains and exceeds the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection, and standards for registrations/insurance verification
Coordinates timely and accurate appointment scheduling across the region with expertise in scheduling protocols, insurance requirements and accurate collection and verification of pre-registration needs on an as needed basis
Communicates and promptly escalates accounts of concern to management.
Must possess the ability to comply with Trinity Health policies and procedures.
Must be comfortable operating in a collaborative, shared leadership environment
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
Other duties as assigned by manager.