Patient Financial Clearance Representative I (Remote)

Stanford Health Care•Hubley Township, PA

18h•$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 coverage and benefits, obtains and follows up on authorizations, coordinates with patients, clinics, and referring providers, and identifies and escalates financial-clearance risks. The role also handles inbound and outbound calls, responds to customer inquiries, documents work, supports other authorization teams, and assists with special projects as needed. This is a remote, full-time, day-shift position with an 08-hour schedule.

Requirements

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

Nice To Haves

Epic experience.

Responsibilities

Complete insurance verification, eligibility, and benefit determinations using electronic eligibility systems, payer websites, and telephone inquiries.
Interpret and document copays, deductibles, share of cost, coinsurance, maximum benefit levels, and available days.
Contact patients to obtain or update information when necessary.
Complete Medicare Secondary Questionnaires when appropriate.
Apply authorization rules and requirements for payers within assigned work queues.
Develop working knowledge of procedures and diagnoses for assigned service lines to ensure authorizations are completed for the services to be provided.
Assess the information required for authorization and financial sponsorship, and communicate with clinics and referring providers to obtain it.
Follow up on pending authorization and referral requests to ensure 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 when authorization is not secured in time, as appropriate.
Notify the department manager about issues, errors, or obstacles to completing work successfully.
Document accounts and communicate through email and internal notes or memos using strong writing skills.
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.
Adopt and execute Stanford Health Care’s C-I-CARE standards and patient-experience pillars in interactions with patients, families, and colleagues.