Patient Financial Clearance Specialist

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The Patient Financial Clearance Specialist is responsible for producing and sharing accurate and timely service estimates (GFE – Good Faith Estimates) to all scheduled patients in addition to verification of insurance and benefit information. This position will project a mature problem-solving attitude with an ability to handle multiple tasks and be flexible and work with minimal supervision. Maintains knowledge of revenue cycle operations, CMS No Surprises Act (NSA) regulations, and compliance requirements, third party reimbursement, local/state/federal regulations, and medical terminology. Exceptional knowledge of CPT codes and procedures is needed. Provides excellent customer service and uses strong written/verbal communication skills, that will be used when communicating the patients out of pocket expenses.

MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High school graduate or GED.
2. State criminal background check and Federal (if applicable), as required for regulated areas.
EXPERIENCE:
1. Two (2) years’ experience in revenue cycle or customer service related role. 

PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Associate degree in a related medical field such as medical assisting or medical office administration is preferred.
2. HFMA Certified Revenue Cycle Representative (CRCR) or similar revenue cycle certification.
3. NAHAM Certified Healthcare Access Associate or similar revenue cycle certification.
4. Knowledge of healthcare insurance plans, coverages and understanding a patient (OOP) out of pocket costs with the ability to communicate that information to the patient, and general knowledge of hospital clinical departments and service protocols. Self-motivated, problem solving, analytical insurance expert with previous clinical working knowledge of testing workflow along with critical thinking ability.
5. Thorough understanding and working knowledge of CPT codes, medical terminology, ability to read and explain back EOB for all insurance types; excellent interpersonal, verbal, and written communication; excellent organizational, analytical; excellent time management and multi-tasking abilities.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1.    Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency. 
2.    Use work queues within the EPIC system to coordinate all financial clearance work.  Keep the WQ’s current and within the required compliance of the NSA.
3.    Follow up with patient, insurance, or provider/department if there are insurance coverage issues for resolution. 
4.    Maintains current knowledge of major payer payment provisions and regulations. 
5.    Assists Patient Financial Services with denial management issues as needed.
6.    Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information. 
7.    Coordinates and assists in the preparation and gathering of summaries, databases, statistical tables, requisitions or special reports, and other data gathering for review by leader. 
8.    Maintains work queue volumes and productivity within established guidelines in order to provide accurate/timely estimates to patients in a manner conducive to the success of WVUM. This will include regular contact with the patient to discuss the estimate and collect any payments needed.
9    Develop tools (e.g. checklists) and observe revenue cycle front-end processes and documents results of gaps for leadership team. Assist with all team objectives to improve the success of the FCT (Financial Clearance Team) by collaborating routinely to help in the success of the department.
10    Communicates found errors to the responsible area and the leadership team and trainer(s) to make sure that training gaps are corrected.
11    Documents accounts clearly and accurately with all activity completed on every account.  Always reviews the activity and notes on the account prior to proceeding with any given activity or research, to clarify the status of the account activity prior.
12.    Maintains positive wor