Patient Financial Clearance Representative

Location: Coos Bay, OR • Full-Time • $21.06 - $36.62 per hour

About the role

The Patient Financial Clearance Representative, under direct supervision of the Revenue Cycle Supervisor, performs specialized functions for CVH patients by completing all activities related to insurance verification, processing referrals, and securing appropriate authorization. This role requires knowledge of healthcare payers such as Commercial, Medicare, Medicaid, Workers’ Compensation, and all Managed Care plans, as well as State and Federal Regulations.

Responsibilities

• Performs pre-registration and financial clearance for multiple patient types (inpatient admissions, outpatient observation, diagnostic outpatients, and ambulatory (day) surgery).
• Completes insurance verification, eligibility, and benefit determination using integrated electronic eligibility systems, payer websites, and phone for all insurance plans.
• Interprets and documents copay, deductible, co-insurance, maximum benefits, and available days.
• Develops a strong working knowledge of procedures and diagnoses in assigned service lines to ensure proper referrals and authorizations.
• Pre-registers patients for upcoming visits, validating and entering demographic, clinical, financial, and insurance information into the patient accounting system.
• Communicates with clinics and referring providers to secure necessary information for referrals or authorizations.
• Prioritizes work to minimize financial risk and ensure timely completion of authorizations.
• Identifies risks in securing financial clearance and escalates issues to clinics or management for resolution (e.g., rescheduling or canceling services).
• Refers cases without timely authorization to financial counseling or management as appropriate.
• Informs patients/guarantors of their financial liabilities and collects co-payments, co-insurances, deductibles, deposits, and outstanding balances at pre-registration.
• Calculates patient liabilities, provides financial education, and refers patients to resource counseling as needed.
• Documents payments and actions in the patient accounting system.
• Validates medical necessity (LMRP/LCD review) for Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Correctly identifies and updates various types of insurance.
• Ensures referrals are addressed in a timely manner, assembling clinical background and referral needs.
• Contacts review organizations and insurance companies to meet prior approval requirements, presenting necessary medical information (e.g., history, diagnosis, prognosis).
• Notifies department manager of issues, errors, or obstacles to successful work completion.
• Manages inbound and outbound calls.
• Assists other departmental personnel and cross-trains in various functions to support smooth departmental operations.
• Performs other duties as assigned.

Requirements

• High school diploma or GED required.
• Minimum one year of experience in one or more of the following roles:
  • Hospital or physician office setting
  • Customer service
• Strong verbal and written communication skills.
• Knowledge of medical terminology recommended.
• HFMA Revenue Cycle Certification (may be obtained during the first year of employment).