Patient Financial Clearance Representative - One Capital Square
About The Position
The Patient Fin Clearance Rep is responsible for the entire scope of financial clearance activities for assigned patients before the scheduled appointment date. Financial clearance includes, but is not limited to, confirming completeness of patient registration data, verifying insurance eligibility, confirming health plan benefits, procuring PCP referrals and health plan authorizations, calculating/ collecting patient liability estimate, restricting/redirecting out of network patient, and communicating patient financial responsibility. The Patient Fin Clearance Rep ensures patient financial responsibility is communicated with consistency, clarity and transparency to ensure patients understand the cost of services they receive, their insurance coverage and limitations, and their individual responsibility. Successful performance of job duties directly impacts health system goals of streamlining clinical operation work flows as well as improving revenue cycle operations and financial performance.
Requirements
- Minimum three (3) years of previous experience in a health care setting to include:
- Experience in commercial, managed care and governmental health insurance plans and
- One (1) year experience in insurance plan authorization and referral requirements; or Medical billing
- Previous experience using a personal computer and various software applications, including Microsoft, e-mail, etc.
- Strong customer service skills and patients/customers centered focus in a positive manner in all situations
- High School Diploma or equivalent
Nice To Haves
- Previous experience using GE-IDX Patient Registration or other medical billing/registration system
- Previous experience in ICD and CPT coding
- Previous experience using medical terminology
- Post high school education in healthcare or medical billing coursework
Responsibilities
- Collects and updates patient demographic and insurance plan information
- Verifies insurance plan eligibility and benefits using multiple system and web-based tools, as well as calling payer and patient as necessary
- Calculates out-of-pocket liability and collects required deposits, co-pays, deductibles and outstanding balances from patient prior to service
- Refers patients to financial counselors when assistance needed to identify alternate payer source or establish payment plan
- Contacts in-house and community primary care physicians to secure PCP referral for consult and treatment as required by health plan
- Contacts health plan to secure prior authorization for procedures/testing as required by health plan
- Coordinates peer-to-peer review between VCUHS physicians and health plan medical directors to secure prior authorization for services
- Prepares all forms required to obtain payment from third party payer for services
- Determines when appropriate to apply additions/revisions to patient account and current visit
- Maintains thorough knowledge of commercial, managed care and governmental health care plans
- Maintains thorough knowledge of insurance plan authorization and referral requirements
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
