Financial Clearance Representative Senior-Transplant

Allina Health • Minneapolis, MN

7d • $26 - $36 • Onsite

About The Position

Allina Health is a not-for-profit health system that cares for individuals, families and communities throughout Minnesota and western Wisconsin. If you value putting patients first, consider a career at Allina Health. Our mission is to provide exceptional care as we prevent illness, restore health and provide comfort to all who entrust us with their care. This includes you and your loved ones. We are committed to providing whole person care, investing in your well-being, and enriching your career.

Key Position Details:
1.0 FTE (80 hours per two-week pay period)
8-hour day shift
No weekends

Requirements

• Must be 18 years of age with education and/or experience needed to meet required functional competencies as listed on the job description
• 5+ years of experience with Insurance and Benefit Verification, Pre-experience with Registration and/or Prior Authorization activities in healthcare business office/insurance operations

Nice To Haves

• High school diploma or GED
• Associate's or Vocational degree in Business Administration, Health Care Administration, Public Health, or Related Field of Study
• Experience working with clinical staff.
• Previous experience working in outpatient and/or inpatient healthcare settings
• Experience working clinical documentation.
• Previous experience working with a patients clinical medical record

Responsibilities

• Performs pre-transplant/VAD insurance screening and verification for all transplant/VAD patient referrals, including enrollment, benefits and deductible and co-pay amounts.
• Determines whether patients have adequate financial resources for transplant/VAD services.
• Communicates results of insurance screening to patient, transplant or VAD coordinator and physician, social worker and financial personnel.
• Prepares letter of request for prior authorization of insurance coverage for transplant/VAD surgery, providing documentation of medical necessity and transplant/VAD candidacy according to criteria.
• Requests prior authorization for transplant related admissions and procedures including mechanical assist device implantation.
• Maintains contact with insurance company to update prior authorizations and determine whether benefits have changed.
• Informs insurance company of patient's transplant or mechanical assist device implant.
• Serves as a resource to patients, families and staff regarding financial issues related to transplantation.
• Coordinates patient billing for transplant and mechanical device implant procedures.
• Serves as resource and hospital representative to third party payers and other health care providers.
• Performs daily Financial Clearance activities.
• Performs financial clearance processes by interviewing patients and collecting and recording all necessary information for pre-registration of patients.
• Educates patients of pertinent policies as necessary i.e., Patient Rights, HIPAA information, consents for treatment, visiting hours, etc.
• Verifies insurance eligibility and completes automated insurance eligibility verification, when applicable and appropriately documents information in Epic.
• Confirms that a patient’s health insurance(s) is active and covers the patient’s procedure.
• Confirms what benefits of a patient’s upcoming visit/stay are covered by the patient’s insurance(s) including exact coverage, effective date of the policy, coverage limitations / requirements, and patient liabilities for the type of service(s) provided.
• Provides proactive price estimates and works with patients so they understand their financial responsibilities
• Informs families with inadequate insurance coverage of financial assistance through government and financial assistance programs and refers the patient to financial counseling.
• Reviews and analyzes patient visit information to determine whether authorization is needed and understands payor specific criteria to appropriately secure authorization and clear the account prior to service where possible.
• Ensures that initial and all subsequent authorizations are obtained in a timely manner.
• Provides mentoring and daily workflow coaching to less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role.
• Performs Enhanced Financial Clearance activities.
• May complete admission reviews for hospital admissions to support the authorization process
• May complete notification of hospital admission and discharge for hospital admissions
• Expanded insurance benefit review for more complex and/or high dollar procedures
• Performs financial counseling with patients; includes evaluating assistance programs the patient may qualify for, completing applications, determining need for delay/cancel of services and escalating as needed
• May be assigned to work special projects and/or non-standard workflows
• Supports Financial Clearance activities.
• Focuses and provide guidance on complex authorization, billing or patient situations.
• Provides technical and functional direction for staff.
• Other duties as assigned.

Benefits

• Medical/Dental
• PTO/Time Away
• Retirement Savings Plans
• Life Insurance
• Short-term/Long-term Disability
• Voluntary Benefits (vision, legal, critical illness)
• Tuition Reimbursement or Continuing Medical Education as applicable
• Student Loan Support Benefits to navigate the Federal Public Service Loan Forgiveness Program

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree