Patient Financial Clearance Navigator

VCU Health; United States; Remote; USD 42,000 - 54,000; Full time

Job summary

VCU Health is seeking a Patient Financial Clearance Representative to manage the full pre-appointment financial clearance process. You will verify patient demographics, insurance eligibility, and plan benefits, and determine patient liability before services are rendered.

Responsibilities include coordinating referrals and prior authorizations, communicating expected patient financial responsibility, and directing patients to financial counselors when needed.

Qualifications

• High School Diploma or equivalent required.
• Experience in health care payer processing beneficial.
• Experience with insurance verification and patient registration preferred.

Responsibilities

• Collects and updates patient demographic and insurance plan information.
• Verifies insurance plan eligibility and benefits using multiple system and web-based tools.
• Calculates out-of-pocket liability and collects deposits, co-pays, deductibles and outstanding balances from patient prior to service.
• Refers patients to financial counselors when assistance needed to identify alternate payer source or establish payment plan.
• Contacts in-house and community primary care physicians to secure PCP referral for consult and treatment as required by health plan.
• Contacts health plan to secure prior authorization for procedures/testing as required by health plan.
• Coordinates peer-to-peer review between VCUHS physicians and health plan medical directors to secure prior authorization for services.
• Prepares all forms required to obtain payment from third party payer for services.
• Determines when appropriate to apply additions/revisions to patient account and current visit.
• Maintains thorough knowledge of commercial, managed care and governmental health care plans.
• Maintains thorough knowledge of insurance plan authorization and referral requirements.

Skills

Customer service

Insurance verification

Medical billing

Data entry

Education

High School Diploma or equivalent

Tools

GE-IDX Patient Registration

MS Office

EMR systems

Job description

VCU Health is seeking a Patient Financial Clearance Representative to manage the full pre-appointment financial clearance process. You will verify patient demographics, insurance eligibility, and plan benefits, and determine patient liability before services are rendered.

Responsibilities include coordinating referrals and prior authorizations, communicating expected patient financial responsibility, and directing patients to financial counselors when needed.