Financial Clearance Rep

About the role

The Financial Clearance Rep is responsible for ensuring accounts are financially cleared prior to the date of service. This key position begins the overall patient's experience and starts the billing process for any services provided by the hospital.

Responsibilities

• Interview patients when they are scheduled to come into the hospital either for an elective outpatient, scheduled surgery or outpatient procedure.
• Gather demographic information (name, address, phone number, social security number, type of insurance coverage, etc.) about the patient.
• Obtain and verify accurate insurance information, benefit validation, authorization and pre-service collections.
• Financially clears patients for each visit type, admit type and area of service via EPIC (Electronic Medical Record- EMR).
• Collects and documents all required demographic and financial information.
• Accurately and efficiently performs registration and financial functions to include: thorough interviewing techniques, pre-registers patients in appropriate status, follows pre-registration guidelines while ensuring the accurate and timely documentation of demographic and financial data.
• Analyze patient insurance(s), identifies the correct insurance plan, selects appropriately from EPIC insurance and plan selections and documents correct insurance order.
• Applies recurring visit processing according to protocol. May facilitate use of electronic registration tools where available (credit card processing, etc.).
• Verifies patient information with third party payers. Collects insurance referrals and documents within EPIC.
• Communicates with patients and physician/offices regarding authorization/referral requirements. Obtains financial responsibility forms or completed electronic forms with patients as necessary.
• Screens outpatient visits for medical necessity. Provides cost estimates. Collects and documents Medicare Questionnaire and obtains information from the patient if third party payers need to be billed (i.e. worker's compensation, motor vehicle accidents and any other applicable payer).
• Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans. Ensures Meaningful Use requirements are met as appropriate.
• Financial Advocacy: Screens all patients self-pay & out of network patients using approved technology. Provides information for follow up and referral to the Benefit Advisor as appropriate. Initiates payment plans and obtains payment. Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family. Incorporates point of service (POS) collection processes into daily functions.
• Collections: Collects CPT and ICD-10 codes. Performs medical necessity check and prepares ABN as appropriate for Medicare primary outpatients.
• Reports: Manages/prepares miscellaneous reports, schedules and paperwork.
• Maintains and exceeds the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection and standards for registrations/insurance verification.

Qualifications

• High School Diploma or equivalent
• CRT-Revenue Cycle Representative, Certified (CRCR) - HFMA Healthcare Financial Management Association
• 1 Year Preferred Associate's Degree or Bachelor's degree in business, management or other related fields.
• 1 year of relevant experience in a customer service role or health care industry.