Patient Financial Clearance Specialist

About the role

A Patient Financial Clearance Specialist produces and shares accurate, timely Good Faith Estimates (GFE) for all scheduled patients, verifies insurance and benefit information, and maintains knowledge of revenue-cycle operations, CMS No-Surprises Act regulations, compliance requirements, third-party reimbursement, and medical terminology.

Responsibilities

• Organize and execute daily tasks in priority order to achieve optimal productivity, accountability, and efficiency.
• Use EPIC work queues to coordinate all financial-clearance activities and keep queues current within NSA compliance.
• Follow up with patients, insurers, or providers to resolve coverage issues.
• Maintain current knowledge of major-payer payment provisions and regulations.
• Assist Patient Financial Services with denial management as needed.
• Protect patient confidentiality per policy when interacting with patients, physicians, families, co-workers, and the public.
• Prepare and gather summaries, databases, statistical tables, requisitions, or special reports for leadership review.
• Develop tools (e.g., checklists) and observe front-end revenue-cycle processes; document gaps for the leadership team.
• Collaborate routinely to improve the success of the Financial Clearance Team.
• Communicate identified errors to responsible areas and trainers to correct training gaps.
• Document all account activity clearly and accurately; review prior notes before proceeding.
• Maintain positive working relationships with internal departments (Patient Financial Services, Coding, HIM, Accounting, physician offices, clinics, Financial Counselors, etc.).
• Verify coverage eligibility and benefits using payer websites, phone numbers, eligibility websites, and other software; add insurance as appropriate.
• Stay current with changes in healthcare delivery, professional standards, regulatory and accrediting-body requirements, and organizational needs.
• Comply with annual competency requirements (Emergency Preparedness, hazards, blood-borne pathogens, universal precautions, infection control, electrical/fire safety, material safety data sheets, etc.).
• Participate in assessments and improvement processes; report results to appropriate administrative levels.
• Comply with Notices of Privacy Practices, Patient’s Rights and Responsibilities, and cooperate with the WVUH Corporate Compliance Program.
• Direct patients needing financial assistance to a Financial Counselor.
• Obtain and enter demographic, billing, and insurance information into registration/billing systems for service and claim processing.
• Respond daily to telephone or email inquiries; document all actions taken.
• Serve as a resource to staff and patients for insurance-related issues.
• Follow through on corrections to demographics and insurance as discovered.
• Process payments according to standard protocol via the billing system.
• Handle inquiries via Jabber and the call center; ensure timely responses and follow-up.

Requirements

• High school diploma or GED.
• State criminal background check and Federal background check (if applicable) for regulated areas.
• Two years’ experience in revenue cycle or customer-service–related role.

Preferred Qualifications

• Associate degree in a related medical field (e.g., medical assisting or medical office administration).
• HFMA Certified Revenue Cycle Representative (CRCR) or similar revenue-cycle certification.
• NAHAM Certified Healthcare Access Associate or similar revenue-cycle certification.
• Knowledge of healthcare insurance plans, coverages, and patient out-of-pocket costs; ability to communicate this information effectively.
• General knowledge of hospital clinical departments and service protocols.
• Self-motivated, problem-solving, analytical insurance expert with previous clinical working knowledge of testing workflow and critical-thinking ability.
• Thorough understanding and working knowledge of CPT codes and medical terminology.
• Ability to read and explain Explanation of Benefits (EOB) for all insurance types.
• Excellent interpersonal, verbal, and written communication skills.
• Excellent organizational, analytical, time-management, and multitasking abilities.

Physical Requirements

• Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling throughout the work shift.
• Must be able to read and write legibly in English; visual acuity must be within normal range.
• Must be able to exert in excess of 50 pounds of force occasionally, up to 25 pounds frequently, and up to 10 pounds constantly to move objects.
• Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.
• Ability to move throughout the work area and clinic.
• Ability to sit or stand for extended periods.
• Reading and comprehension ability.

Working Environment

• Remote, work-from-home position.
• Capable of performing assigned tasks despite frequent interruptions.
• Capable of working within a confined office space and under fluorescent lighting.
• Ability to maintain concentration in and around noise from office machinery (e.g., copier, printer).
• High-volume, fast-paced environment.
• Exposure to communicable disease.
• Daily interaction with patients, medical staff, and support staff.

Skills

• Ability to accurately utilize applicable computer software and equipment for access processing; demonstrate ability to follow downtime procedures.
• Knowledge of procedures to report and/or document unsafe/hazardous conditions, incidents, and defective equipment in compliance with hospital policy.
• Ability to perform repetitious duties throughout the shift.
• Considerable attention to detail, organization, and ability to perform multiple tasks simultaneously.
• Ability to memorize a considerable amount of information and reference information from written sources or personnel.
• Understanding of medical insurance requirements for payment and basic knowledge of covered services.
• Ability to work with a variety of personality types and interact with individuals of various education levels, capabilities, and communication skills.

Schedule

Scheduled weekly hours: 40