Remote Financial Clearance II - 3rd Shift

Employment Type: Full time
Shift: 12 Hour Day Shift (Thursday – Saturday, 6:00 PM – 6:30 AM CST)

About the role

Responsible for ensuring all pre-service accounts are financially cleared and secured prior to the date of service for Trinity Health. This role handles complex, high-dollar services including surgical, observation, and in-house services. Performs work in multiple areas of verification: Outpatient verification, Elective Short Procedure/Inpatient verification, Urgent Admission verification, or Scheduling. Responsibilities include obtaining and verifying accurate insurance information, benefit validation, authorization, and preservice collections. This is a key position that begins the overall patient experience and initiates the billing process for services provided by the hospital.

Responsibilities

• Financially clear patients for each visit type, admit type, and area of service via current Health Information System (HIS).
• Collect and document all required demographic and financial information.
• Activate registration and discharges in an appropriate and timely fashion.
• Coordinate with Care Management for level of care, Medicare Inpatient Only list, and required authorizations.
• Coordinate with OR Scheduling on date of service changes, revisions, or cancellations and process accordingly.
• Analyze patient insurance(s), identify the correct insurance plan, select appropriately from HIS insurance and plan selections, and document correct insurance order.
• Apply recurring visit processing according to protocol.
• Verify patient information with third-party payers, collect insurance referrals, and document within HIS.
• Communicate with patients and physician offices regarding authorization/referral requirements.
• Identify potential need for financial responsibility forms or completed electronic forms with patients as necessary.
• Escalate accounts appropriately in accordance with department Defer/Delay policy to manager.
• Screen outpatient visits for medical necessity and issue Advanced Beneficiary Notice as appropriate for Medicare primary outpatients.
• Provide cost estimates and collect/document Medicare Secondary Payer Questionnaire (MSPQ).
• Obtain information from the patient if third-party payers need to be billed (e.g., worker’s compensation, motor vehicle accidents).
• Maintain operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans.
• Ensure Meaningful Use requirements are met as appropriate.
• Screen all self-pay and out-of-network patients using approved technology.
• Provide information for follow-up and referral to the RHM Medicaid Vendor and/or Financial Counselor as appropriate.
• Initiate payment plans and obtain payment.
• Inform and explain all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family.
• Incorporate point-of-service (POS) collection processes into daily functions.
• Issue receipts and complete cash balance sheets in specified areas where appropriate.
• Utilize audits and controls to manage cash accurately and safely.
• Maintain and exceed department-specific individual productivity standards, collection targets, and quality audit scores for accuracy, productivity, and registration/insurance verification.
• Coordinate timely and accurate appointment scheduling across the region with expertise in scheduling protocols, insurance requirements, and accurate collection/verification of pre-registration needs.
• Communicate and promptly escalate accounts of concern to management.
• Maintain a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program, and Code of Conduct.
• Perform other duties as assigned by manager.

Requirements

• High School Diploma or equivalent combination of education and experience.
• Comprehensive knowledge of financial clearance and insurance verification processes with three (3) years of financial clearance experience in an acute care setting.
• Experience processing financial clearance for complex services including surgical services, observation, and in-house cases.
• Strong knowledge of third-party and government payer billing and reimbursement guidelines, as well as department performance standards and policies.
• National certification in HFMA CRCR and/or NAHAM CHAA within one (1) year of hire.
• Ability to communicate and work with patients, physicians, physician office personnel, associates, and multiple direct patient care providers to expedite the registration/intake process.
• Superior customer service skills and etiquette.
• Proficient in the use of Patient Registration/Patient Accounting systems and related software systems.
• Proficient in the use of Microsoft Office business software.
• Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.
• Comfortable operating in a collaborative, shared leadership environment.
• Personal presence characterized by honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Pay

Hourly Pay Range: $18.02 – $27.00

Working Conditions

• Operates remotely in an in-home environment or in an onsite typical office environment (well-lit, temperature-controlled, and hazard-free).
• Frequent communication, in person and over the phone, with people in all locations on product support issues.
• Manual dexterity needed to operate a keyboard.
• Hearing required for extensive telephone and in-person communication.
• Ability to concentrate, meet deadlines, work on several projects simultaneously, and adapt to interruptions.
• Must be able to set and organize own work priorities and adapt to changing priorities.
• Ability to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
• Ability to thrive in a fast-paced, multi-customer environment with conflicting needs, which some may find stressful.
• May require varied and/or extended hours with changes in workload and priorities to keep pace with the industry and advance strategic priorities.
• Must comply with Trinity Health policies and procedures.