Position Summary: The Financial Clearance Representative (FCR) is responsible to ensure patients presenting for services are financially cleared prior to service. This is to include pre-registration, validating eligibility and benefits, referral, prior authorization, price estimating, obtain or provide payment options pre-service and communicating with the patient and/or collaborating with the practice or department.
The Financial Clearance Representative (FCR) is responsible to complete validation process prior to service which includes full pre-registration, eligibility, benefit verification and price estimator, contacting insurance plans to obtain prior authorization and medical policies. Process referrals and prior authorizations within 24-48 hours of receipt of the task. FCR is responsible to accurately document and report completions of process following standard work of Financial Clearance. FCR is responsible to identify, interpret and communicate findings that do not meet financial clearance criteria. FCR is responsible to communicate to the appropriate department, practice or provider when key data elements including medical necessity are missing or not met that require review to continue with the clearance process. FCR is responsible to communicate payment risk and collaborate with Financial Counselors to complete the financial clearance process. The FCR is responsible to engage management when issues or concerns result in failure to meet deadlines or financial clearance expectations.
Education and Experience:
High School graduate
Minimum of three years relevant or medical office experience
Health insurance knowledge
Knowledge of medical terminology preferred
Knowledge, Skills and Abilities:
Strong computer skills including navigating various websites, and applications
Strong problem solving skills
Effective communication both verbal and written
Ability to work collaboratively
Candidate will continue to meet and complete ongoing training enhancing skills needed in this position.