Patient Financial Clearance Representative

Mosaic Life Care•Saint Joseph, MO

About The Position

The Patient Financial Clearance Representative works under the direction of the responsible Manager to ensure financial records are accurate and complete before patients arrive. As an initial point of contact in the patient experience, the representative is expected to provide excellent customer service and help shape patients’ perceptions of Mosaic Life Care. The role serves as a liaison between ordering offices and Mosaic Life Care to obtain patient information and prior-authorization details for scheduled services. It also pre-certifies insurance for scheduled procedures and tests to expedite reimbursement and avoid authorization penalties. The representative contacts patients before scheduled services to review estimated out-of-pocket costs, request payment when appropriate, discuss prior balances, explain financial assistance and financing options, and address coverage limitations. The role verifies insurance eligibility and registration information, assists with billing questions and complaints, and supports department call-handling standards. The position may require travel to off-site locations and a varied schedule that includes evening and weekend coverage.

Requirements

One year of experience with pre-access services policies.
Excellent oral and written communication skills.
Ability to maintain a friendly, courteous, helpful, and professional relationship with patients and caregivers.
Ability to communicate clearly and concisely.
Ability to analyze and interpret data.
Excellent short-term and long-term memory.
Ability to multitask and follow system policies and procedures.
Ability to operate a computer, telephone, fax, and copier continuously or repetitively.
Ability to visually assess paper and electronic data, hear telephone communications, and converse.
Demonstrated ability to work independently and manage individual workload to meet productivity standards.
Ability to work a varied schedule that includes evening and weekend coverage.
Ability to quickly assess and respond appropriately to emergency situations.
Ability to comprehend medical terminology.
Analytical skills to resolve complex problems using scientific, mathematical, or technical principles.
Knowledge and experience with information systems and Internet usage.
Experience with spreadsheet and word processing software.
Good hand-eye coordination and organizational skills.

Nice To Haves

High school diploma or equivalent preferred.
Associate’s degree preferred.

Responsibilities

Make outbound pre-service calls to patients with upcoming scheduled services.
Communicate professionally, courteously, and clearly with patients.
Review estimated out-of-pocket costs for clinic and medical center services and request payment by phone before the service.
Communicate previous patient balances.
Explain Mosaic Life Care’s Financial Assistance Policy and evaluate patient needs based on the PARO score.
Discuss out-of-network and non-covered services so patients are prepared for potential out-of-pocket expenses.
Confirm insurance eligibility for the date of service and research other coverage when a patient is not eligible.
Evaluate whether patients unable to pay estimated out-of-pocket costs may qualify for Mosaic’s loan financing program.
Confirm registration data with patients and update demographic information as needed.
Verify health insurance information with patients for billing accuracy.
De-escalate complaints related to current or past-due balances.
Research the Patient Accounting system to answer questions about registration, charging, and billing for previous visits.
Meet department standards for call length and speed to answer, and help prevent abandoned calls.
Perform other duties as assigned.
Travel to off-site locations as required.