REMOTE Financial Clearance II

Trinity Health•Livonia, MI

20h•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.
Comprehensive knowledge of financial clearance and insurance verification processes with three (3) years of financial clearance experience in an acute care setting.
Experience 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.
Proficiency in the use of Patient Registration/Patient Accounting systems and related software systems.
Proficiency in the use of Microsoft Office business software.
Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.
Comfortable operating in a collaborative, shared leadership environment.
Possess a personal presence 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.

Nice To Haves

Superior customer service skills and etiquette is strongly preferred.

Responsibilities

Financially clearing patients for each visit type, admit type and area of service via current HIS (Health Information System).
Collecting and documenting all required demographic and financial information.
Activating registration and discharges in an appropriate and timely fashion.
Coordinating with Care Management for level of care, Medicare Inpatient Only list, and required authorizations.
Coordinating with OR Scheduling on date of service changes and/or other revisions or cancellations and processes accordingly.
Analyzing patient insurance(s), identifying the correct insurance plan, selecting appropriately from HIS insurance and plan selections and documenting correct insurance order.
Applying recurring visit processing according to protocol.
Verifying patient information with third party payers.
Collecting insurance referrals and documenting within HIS.
Communicating with patients and physician/offices regarding authorization/referral requirements.
Identifying potential need for financial responsibility forms or completed electronic forms with patients as necessary.
Escalating accounts appropriately in accordance with department Defer/Delay policy to manager.
Screening outpatient visits for medical necessity and issuing Advanced Beneficiary Notice as appropriate for Medicare primary outpatients.
Providing cost estimates.
Collecting and documenting Medicare Secondary Payer Questionnaire (MSPQ) and obtaining 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).
Maintaining operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans.
Ensuring Meaningful Use requirements are met as appropriate.
Screening all patients self-pay & out of network patients using approved technology.
Providing information for follow up and referral to the RHM Medicaid Vendor and/or Financial Counselor as appropriate.
Initiating payment plans and obtaining payment.
Informing and explaining all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family.
Incorporating point of service (POS) collection processes into daily functions.
May issue receipts and complete cash balance sheets in specified areas where appropriate.
Utilizing audits and controls to manage cash accurately and safely.
Maintaining and exceeding the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection, and standards for registrations/insurance verification.
Coordinating 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.
Communicating and promptly escalating accounts of concern to management.
Complying with Trinity Health policies and procedures.
Operating in a collaborative, shared leadership environment.
Maintaining 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.
Performing other duties as assigned by manager.