Financial Clearance Representative
Category: Clerical
Facility: Genesis Healthcare System
Department: Financial Clearance
Schedule: Full Time
Shift: Day Shift
Hours: 64 bi-weekly / 8:30am-5:00pm
Contact Information: Contact: Human Resources
Job Details:

JOB SUMMARY

The Financial Clearance Representative obtains and/or verifies demographic, clinical, financial and insurance information in the process of pre-registering and financial clearing patients for service delivery.  The incumbent conducts online insurance eligibility/benefit verification, pre-certification/authorization, referral clearance and financial education on designated cases.  As appropriate, the incumbent notifies patient/guarantor and collects patient liabilities, and refers appropriate cases to resource counseling for follow-up and consultation. 

ESSENTIAL DUTIES

1.       Performs pre-registration and financial clearance for multiple patient types (inpatient admissions, outpatient observation and bedded outpatients, diagnostic outpatients, ambulatory surgery, emergency department registrations, series accounts, etc.).

2.       Communicates with patients, family members/guarantors, 3rd party payers, employers and physicians/office staff in the deployment of key activities. 

3.       Pre-registers the patient for upcoming visit(s), including validating/obtaining and entering demographic, clinical, financial, and insurance information into the patient accounting system. 

4.       Provides information regarding directions, parking, transportation service, overnight accommodations, etc. during pre-registration calls.

5.       Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the patient accounting system. 

6.       Determines the need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and contacts the physician and case management/utilization review personnel, as necessary. 

7.       Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.  Calculates patient liabilities and provides financial education, referring the patient to resource counseling, as required.  Documents payments/actions in the patient accounting system and provides the patient with a payment receipt.  

8.       Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.  Contacts scheduling and/or ancillary department staff for clarification, if cases require clarification of diagnosis and/or tests/procedures.

9.       May prepare special reports as directed by the manager to document utilization of the pre-service unit's services and patient flow (e.g., patient service time, call volume, etc.). 

10.    May provide assistance to other departmental personnel as needed.  Cross-trains in various functions as needed to assist in the smooth delivery of departmental services. 

11.    Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Genesis organizational integrity program, standards of conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

12.    Other duties as needed and assigned by the Manager.

 

QUALIFICATIONS

1.       High school diploma or equivalent required. 

2.       Certified Healthcare Access Associate (CHAA) by the National Association of Healthcare Access Management (NAHAM).

3.       Past work experience of at least one (1) year within a physician office, hospital or clinic environment, performing pre-registration and financial clearance activities or an insurance company, performing payer activities.

4.       Working knowledge of medical terminology, anatomy and physiology, and basic computer skills are high desirable. 

5.       Must possess excellent verbal and written communication skills.  Interpersonal skills are necessary in dealing with internal and external customers. 

6.       Accuracy, attentiveness to detail and time management skills are mandatory traits. 

7.       Must have a thorough knowledge of various insurance documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account, from information obtained from the patient/family.

8.       Must be comfortable operating in a collaborative, shared leadership environment.

9.       Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring.

 

WORKING CONDITIONS/PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential function of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  

 

1.       Position operates in an office environment.  Work area is well-lit, temperature controlled and free from hazards.  The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen.  The noise level is low to moderate.

2.       Requires the ability to comprehend and retain information that can be applied to work procedures, including the assimilation of multiple test modalities and judgment in test sequencing to achieve appropriate timing of testing and patient flow.

3.       Occupational exposure to blood or other potentially infectious materials may reasonably be anticipated from the performance of the employee's duties.  Skin, eye, mucous membrane, and/or parenteral contact with blood or potentially infectious material is reasonably anticipated. 

4.       May travel to other floors and to centralized files.  Answers telephone calls, uses personal computer and other business machines extensively.  Bends, reaches, pushes and pulls file drawers to file records and reports.

5.       Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.

6.       Vision abilities required include up close vision, peripheral vision, depth perception and the ability to adjust focus.

7.       May be required to periodically rotate shifts and regular days off.  All system employees must be willing to work all shifts, extra hours, holidays and emergency shifts as required.

 

This description reflects in general terms the type and level of work performed.  It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

 

 




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