Financial Clearance Representative - Behavioral

Fairview Health Services•Minneapolis, MN

97d

About The Position

This position is responsible for completing the financial clearance process within Mental Health and Addiction Patient Access for acute inpatient hospitalizations, routine outpatient evaluations, and routine mental health care authorizations. This is a higher-level position in the FSC that requires understanding of and working with multiple insurance payors to secure benefits and increase the likelihood of reimbursement for Fairview at the highest benefit level. The Financial Clearance Rep (FCR) makes the decision when and how to work with psychiatry providers, insurance payors and other external sources to assist families in obtaining healthcare and financial services.

Requirements

Four (4) years’ experience working in revenue cycle, insurance verification/eligibility, financial securing, or related areas.
Experience with practice management software, hospital billing software or electronic health record software.
Or, two (2) years’ experience working in revenue cycle, insurance verification/eligibility, financial securing, or related areas in combination with an Associate degree in Healthcare related field.

Nice To Haves

Prior Authorization Experience
Previous Epic experience
1 year in a mental health setting

Responsibilities

Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration of patients. Ensures that proper insurance payor plan choice and billing address are assigned in the automated patient accounting system. Verify relevant group/ID numbers as well as ensuring the proper behavioral account is attached to each hospital account record (HAR) to ensure payment for services.
The FCR must be able to effectively articulate payor information in a manner such that patients, guarantors, and family members gain a clear understanding of their financial responsibilities.
The FCR will be responsible for completing the insurance and benefits verification to determine the patient’s benefit level. They will screen payor medical policies to determine if the scheduled procedure meets medical necessity guidelines, submit, and manage referrals and authorization requests/requirements when necessary, and/or ensure that pre-certification and admissions notification requirements, both inpatient and outpatient, are met per payor guidelines. They will provide support and process prior authorization appeals and denials, when necessary, in conjunction with revenue cycle and clinical staff.
Verifies insurance eligibility. Completes automated insurance eligibility verification, when applicable and appropriately documents information in Fairview’s patient accounting system.
Determines the patient’s insurance type and educates patients regarding coverage and/or coverage issues and ensures the proper behavioral payer account is uploaded to ensure reimbursement and reduce denials.
Informs families, providers, and behavioral Utilization Management teams with inadequate insurance coverage regarding financial assistance through government and Fairview financial assistance programs. Performs initial financial screening and refers accounts for financial counseling.
Initiates treatment authorization requests and pursues referrals per payor guidelines. Reviews medical chart/history and physician order(s) to determine likely ICD and CPT codes that are billable services for the appropriate level of care.
Reviews payor medical policies to determine if procedures meet medical necessity guidelines.
Works with behavioral Utilization Management teams, mental health providers, clinics and ancillary service departments if medical necessity fails.
Follow up with insurance payors on prior authorization denials. Process authorization denial appeals, when necessary.
Educates patients and attempts to collect co-payments, co-insurance, and deductibles per Fairview’s POS collections policies and procedures.
Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served
Partners with patient care giver in care/decision making.
Communicates in a respective manner.
Ensures a safe, secure environment.
Individualizes plan of care to meet patient needs.
Modifies clinical interventions based on population served.
Provides patient education based on as assessment of learning needs of patient/care giver.
Fulfills all organizational requirements
Completes all required learning relevant to the role
Complies with and maintains knowledge of all relevant laws, regulations, policies, procedures, and standards.
Fosters a culture of improvement, efficiency, and innovative thinking.
Performs other duties as assigned