Patient Financial Clearance Representative - One Capital Square - Remote

About the role

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.

Responsibilities

• 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
• Contact health plan to secure prior authorization for procedures/testing as required by health plan
• Captures and updates patient demographic and insurance plan information
• Coordinates peer-to-peer review between VCUHS physicians and health plan medical directors to secure prior authorization 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

Requirements

Licensure, Certification, or Registration Requirements for Hire: N/A

Licensure, Certification, or Registration Requirements for continued employment: N/A

Experience REQUIRED: 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

Experience PREFERRED: 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

Qualifications

Education/training REQUIRED: High School Diploma or equivalent

Education/training PREFERRED: Post high school education in healthcare or medical billing coursework

Skills

Independent action(s) required: Collects and updates patient demographic and insurance plan information

May require work hours to periodically extend to 8:00 p.m. as necessary to resolve backlog or to contact patients for registration data.

Age Specific groups served

All

Physical Requirements

• Physical - Lifting 20-50 lbs.
• Activities: Prolonged sitting, Reaching (overhead, extensive, repetitive), Repetitive motion
• Other: Prolong PC/keyboard usage

Mental/Sensory

• Strong recall
• Reasoning
• Problem solving
• Hearing
• Speak clearly
• Write legibly
• Reading
• Logical thinking

Emotional

• Fast pace environment
• Steady pace
• Able to handle multiple priorities
• Frequent and intense customer interactions
• Noisy environment
• Able to adapt to frequent change