Financial Clearance Representative

Prime Healthcare • Lewiston, ME

2d

About The Position

Overview Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoastal Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. Responsibilities Central Maine is seeking a Full Time, Patient Financial Clearance Representative to join our team in Lewiston ! Position Summary: The Financial Clearance Representative (FCR) is responsible to ensure patients presenting for services are financially cleared prior to service. This is to include pre-registration, validating eligibility and benefits, referral, prior authorization, price estimating, obtain or provide payment options pre-service and communicating with the patient and/or collaborating with the practice or department.

Requirements

• High School graduate
• Minimum of three years relevant or medical office experience
• Health insurance knowledge
• Knowledge of medical terminology preferred

Responsibilities

• Complete validation process prior to service which includes full pre-registration, eligibility, benefit verification and price estimator, contacting insurance plans to obtain prior authorization and medical policies.
• Process referrals and prior authorizations within 24-48 hours of receipt of the task.
• Accurately document and report completions of process following standard work of Financial Clearance.
• Identify, interpret and communicate findings that do not meet financial clearance criteria.
• Communicate to the appropriate department, practice or provider when key data elements including medical necessity are missing or not met that require review to continue with the clearance process.
• Communicate payment risk and collaborate with Financial Counselors to complete the financial clearance process.
• Engage management when issues or concerns result in failure to meet deadlines or financial clearance expectations.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED