FINANCIAL CLEARANCE REPRESENTATIVE
The Financial Clearance Representative is responsible for ensuring that payers are prepared to reimburse for scheduled services in accordance with the payer-provider contract. When physicians and clinicians make care decisions, this individual is aware of how a patient?s benefits fit into the care plan, and keeps patients and physicians informed of such as they seek to obtain authorizations from payers. This role contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. In all encounters with patients, families, physicians and their staff will strive for the highest level of customer service. The efficiency of obtaining accurate information, while providing excellent customer service is an essential function of this job.
- 1. Verifies patients' insurance and benefits information.
- 1.1 Responsible for any verification (IP and OP) of authorizations obtained by non YNHHS, YMG, NEMG.
- 2. Obtains prior authorizations from third-party payers in accordance with payer requirements.
- 2.1 Utilizes all necessary Epic applications from booking to obtain procedure codes as needed.
- 3. Maintains professional approach at all times when communicating with patients, co-workers, payer representatives and patients to ensure a positive and professional experience.
- 3.1 Contacts patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary.
- 4. Performs other duties as assigned by Supervisor.
- 4.1 Identifies and recommends opportunities to improve Patient Access or Financial Clearance activities.
High school graduate or GED required with work in healthcare or business preferred. Associate Degree preferred.
One (1) to two (2) years of work experience with insurance authorization/verification of benefits, revenue cycle functions, hospital/physician offices, or related areas required.
Strong organizational skills and ability to prioritize tasks. Strong interpersonal skills and ability to build rapport with a wide variety of individuals. Working knowledge of Microsoft Office, Word, and Excel. Familiarity with medical terminology and healthcare insurance processes. Knowledge of payer reimbursement processes and insurance terminology.
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