Patient Financial Clearance Representative I (Remote)

Stanford Health Care

1d•$34 - $39•Remote

About The Position

The Patient Financial Clearance Representative performs specialized patient financial clearance functions under the direct supervision of Department Management and the Patient Financial Clearance Lead. The role completes insurance verification and authorization activities in accordance with Stanford Health Care regulations, policies, and procedures. It requires knowledge of healthcare payers, including Medicare, Medi-Cal, Workers' Compensation, and managed care plans, as well as applicable state and federal regulations. The representative verifies insurance eligibility and benefits, applies payer authorization requirements, obtains and follows up on authorizations, identifies and escalates financial clearance risks, and communicates with patients, clinics, referring providers, and payers. The position also supports customer inquiries, documentation, phone communications, team projects, and other duties as assigned.

Requirements

High school diploma or GED equivalent.
One year of working knowledge of patient registration and insurance verification and authorization processes in a medical organization.

Nice To Haves

Epic experience.

Responsibilities

Complete insurance verification, eligibility, and benefit determination using electronic eligibility systems, payer websites, and phone calls for assigned service lines.
Interpret and document applicable copays, deductibles, share of cost, coinsurance, maximum benefit levels, and available days.
Contact patients when necessary to obtain correct and updated information.
Complete Medicare Secondary Questionnaires as appropriate.
Apply authorization rules and requirements for payers within assigned work queues.
Develop working knowledge of procedures and diagnoses used in assigned service lines to ensure authorizations cover the services to be provided.
Assess information needed for authorization and sponsorship; communicate with clinics and referring providers to obtain it.
Follow up on pending authorization and referral requests to support timely completion and sponsorship.
Coordinate escalation for clinics and clinicians to complete peer-to-peer appeal reviews with payer utilization management when needed.
Prioritize assigned work to minimize financial risk, complete authorizations on time, and meet daily productivity goals.
Identify coverage, benefit, and financial-clearance risks and escalate them to appropriate experts, clinics, or other resources.
Refer cases to financial counseling as appropriate when timely authorization is not secured.
Notify the department manager about issues, errors, or obstacles to successful completion of work.
Document account information and communicate through email and internal notes or memos.
Manage inbound and outbound phone calls and respond promptly to customer inquiries.
Assist the team coordinator and department manager with special projects as needed.
Serve as a resource for other payer authorization teams.
Perform other duties and responsibilities as assigned by the Department.