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 patients’ financial records are accurate and complete before arrival. As an initial point of contact in the patient experience, the representative is expected to provide excellent customer service and help shape patients’ impressions 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 support reimbursement and avoid authorization penalties. The representative contacts patients before scheduled services to review estimated out-of-pocket costs, request payment when appropriate, explain financial assistance and financing options, confirm insurance eligibility and registration information, and address questions about prior balances and billing. The role may require travel to off-site locations and includes varied scheduling with weekend and evening coverage.

Requirements

One year of experience with pre-access services policies.
Excellent oral and written communication skills, including clear and concise communication.
Ability to maintain rapport and professional relationships with caregivers and provide friendly, courteous, helpful customer service.
Ability to operate a computer, telephone, fax, and copier on a continuous or repetitive basis.
Ability to sit, walk, and stand.
Ability to analyze and interpret data, maintain short- and long-term memory, multitask, and follow system policies and procedures.
Ability to visually assess paper and electronic data, hear telephone conversations, and converse.
Demonstrated self-starter, organizational, and interpersonal skills.
Ability to assess and respond appropriately to emergency situations.
Ability to comprehend medical terminology and use analytical skills to resolve complex problems using scientific, mathematical, or technical principles.
Knowledge and experience with information systems and Internet use, as well as spreadsheet and word-processing software.
Ability to work independently, manage an individual workload to productivity standards, and work a varied schedule that includes weekend and evening coverage.
Travel to off-site locations may be required.

Nice To Haves

High school diploma.
Associate’s degree.

Responsibilities

Make outbound pre-service calls to patients with upcoming Mosaic Life Care appointments or services, communicating professionally and courteously.
Review estimated out-of-pocket costs for clinic and medical center services and request payment before service; communicate previous balances due.
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 understand potential out-of-pocket expenses before service.
Review 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 patients’ health insurance information to support accurate billing.
De-escalate complaints about current or past-due balances and research the Patient Accounting system to answer questions about registration, charges, 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.