Patient Financial Clearance Representative

4 days ago

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VCU Health

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Cardiology • Cancer Care • Pediatrics • Transplant • nursing

10,000+

Description

• Responsible for the entire scope of financial clearance activities for assigned patients before the scheduled appointment date. • Financial clearance includes 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. • Ensures patient financial responsibility is communicated with consistency, clarity and transparency to ensure patients understand the cost of services they receive, their insurance coverage and limitations, and their individual responsibility. • Successful performance of job duties directly impacts health system goals of streamlining clinical operation work flows as well as improving revenue cycle operations and financial performance. • Independent action(s) required include collecting and updating patient demographic and insurance plan information, verifying insurance plan eligibility and benefits, calculates out-of-pocket liability, referring patients to financial counselors, contacting primary care physicians, securing prior authorization, coordinating peer-to-peer review, preparing payment forms, and determining account revisions.

Requirements

• Minimum three (3) years of previous experience in a health care setting • Experience in commercial, managed care and governmental health insurance plans • One (1) year experience in insurance plan authorization and referral requirements • 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 • Previous experience using GE-IDX Patient Registration or other medical billing/registration system (Preferred) • Previous experience in ICD and CPT coding (Preferred) • Previous experience using medical terminology (Preferred)