Financial Clearance Rep

Perform all Financial Clearance duties to ensure the account is financially cleared prior to service. The Financial Clearance Rep is responsible for gathering demographic information (i.e. name, address, phone number, social security number, type of insurance coverage, etc.) about the patient. This key position begins the overall patient's experience and starts the billing process for any services provided by the hospital. This position is responsible for obtaining and verifying accurate insurance information, benefit validation, authorization and pre-service collections.

Financially clears patients for each visit type, admit type and area of service via EPIC (Electronic Medical Record- EMR). Collects and documents all required demographic and financial information. Appropriately activates registration and discharges in a timely fashion.

Accurately and efficiently performs registration and financial functions to include: thorough interviewing techniques, pre-registers patients in appropriate status, follows pre-registration guidelines while ensuring the accurate and timely documentation of demographic and financial data. Analyze patient insurance(s), identifies the correct insurance plan, selects appropriately from EPIC insurance and plan selections and documents correct insurance order. Applies recurring visit processing according to protocol. May facilitate use of electronic registration tools where available (credit card processing, etc.).

Verifies patient information with third party payers. Collects insurance referrals and documents within EPIC. Communicates with patients and physician/offices regarding authorization/referral requirements. Obtains financial responsibility forms or completed electronic forms with patients as necessary.

Screens outpatient visits for medical necessity. Provides cost estimates. Collects and documents Medicare Questionnaire and obtains information from the patient if third party payers need to be billed (i.e. worker's compensation, motor vehicle accidents and any other applicable payer). Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans. Ensures Meaningful Use requirements are met as appropriate.

Financial Advocacy: Screens all patients self-pay & out of network patients using approved technology. Provides information for follow up and referral to the Benefit Advisor as appropriate. Initiates payment plans and obtains payment. Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family. Incorporates point of service (POS) collection processes into daily functions.

Collects CPT and ICD-10 codes. Performs medical necessity check and prepares ABN as appropriate for Medicare primary outpatients.

Manages/prepares miscellaneous reports, schedules and paperwork. Maintains inventory of supplies.

Maintains and exceeds the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection and standards for registrations/insurance verification.