Patient Financial Clearance Representative - One Capital Square - Remote

VCUHSA VCU Health System Authority; Raleigh (NC); Remote; USD 24,000 - 36,000; Full time

Job summary

VCU Health seeks a Patient Fin Clearance Rep to manage financial clearance for scheduled appointments. You will verify registrations, insurance eligibility, plan benefits, and collect patient liabilities before services. Strong customer service and knowledge of varied payer plans are essential.

You will coordinate with financial counselors and PCPs for referrals and authorizations, ensuring clear communication of patient financial responsibilities and compliance with payment policies.

Qualifications

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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 balances before service
• Refers patients to financial counselors for assistance with payment options
• Contacts PCPs to secure referrals and health plan prior authorizations
• Coordinates prior authorizations between physicians and health plans
• Prepares forms to obtain payment from third party payers
• Maintains knowledge of commercial, managed care and government health plans
• Keeps up-to-date on insurance authorization and referral requirements

Skills

Customer service

Insurance knowledge

Data accuracy

Education

High School diploma

Tools

GE-IDX Patient Registration

Medical billing software

ICD/CPT coding

Job description

Approved Remote States: AL, AR, FL, GA, KS, KY, MD, MI, MO, MS, NC, OH, SC, TN, TX, VA, WV

The Patient Fin Clearance Rep is responsible for the entire scope of financial clearance activities for assigned patients before the scheduled appointment date. Financial clearance includes, but is not limited to, confirming completeness of patient registration data, verifying insurance eligibility, confirming health plan benefits, procuring PCP referrals and health plan authorizations, calculating/ collecting patient liability estimate, restricting/redirecting out of network patient, and communicating patient financial responsibility. The Patient Fin Clearance Rep ensures patient financial responsibility is communicated with consistency, clarity and transparency to ensure patients understand the cost of services they receive, their insurance coverage and limitations, and their individual responsibility. Successful performance of job duties directly impacts health system goals of streamlining clinical operation work flows as well as improving revenue cycle operations and financial performance.

Licensure, Certification, or Registration Requirements for Hire: N/A Licensure, Certification, or Registration Requirements for continued employment: N/A

Experience REQUIRED: Minimum three (3) years of previous experience in a health care setting to include: Experience in commercial, managed care and governmental health insurance plans and One (1) year experience in insurance plan authorization and referral requirements; or Medical billing Previous experience using a personal computer and various software applications, including Microsoft, e-mail, etc. Strong customer service skills and patients/customers centered focus in a positive manner in all situations

Experience PREFERRED: Previous experience using GE-IDX Patient Registration or other medical billing/registration system Previous experience in ICD and CPT coding Previous experience using medical terminology

Education/training REQUIRED: High School Diploma or equivalent

Education/training PREFERRED: Post high school education in healthcare or medical billing coursework

Responsibilities

• Collects and updates patient demographic and insurance plan information
• Verifies insurance plan eligibility and benefits using multiple system and web-based tools, as well as calling payer and patient as necessary
• Calculates out-of-pocket liability and collects required 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

Supervisory responsibilities (if applicable): N/A

Additional position requirements: May require work hours to periodically extend to 8:00 p.m. as necessary to resolve backlog or to contact patients for registration data.

Age Specific groups served: All

Physical Requirements

Physical Requirements (includes use of assistance devices as appropriate): Physical - Lifting 20-50 lbs. Activities: Prolonged sitting, Reaching (overhead, extensive, repetitive), Repetitive motion, Other: Prolong PC/keyboard usage Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking, Other: Concentrate/Focus Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change

Compensation Range: $17.50 - $26.39 Actual salary offers will be based on several key factors to include relevant work experience, credentials, and qualifications.

Compensation Range: $17.50 - $26.39 Actual salary offers will be based on several key factors to include relevant work experience, credentials, and qualifications.

EEO Employer/Disabled/Protected Veteran

Who We Are

Inventing better care, day by day by discovery. Sound outrageous? It absolutely is. Sound impossible? That's never stopped us before. Sound like hard work, intense research, collaboration with experts around the world, sheer brainpower meets unrelenting willpower? That's. Exactly. Right. We'll do whatever it takes to offer the best in care and empower the best in quality of life. And it's an approach that works - whether it's a patient who undergoes a new, life-saving procedure or a clinical researcher who finds promise in a new cancer treatment, exciting new medicine is happening at VCU Health. We have it all:

• One college and four health sciences schools
• An academic medical center
• A Level I trauma center
• One of only two NCI-designated cancer centers in Virginia
• The region's only full-service children's hospital
• More than 800 physicians in 200 specialties
• With a community health center, dedicated research teams, facilities and valued partners in every field

Our medical teams are top notch. And we're not too shy to boast of internationally known physicians, some recognized as the best in the country, top-ranked local specialists and all-around all-stars at every level. From our very first years to our most recent advancements, we are driven to learn more, dig deeper, teach passionately and never rest in order to be a true leader in discovering what's possible in health and recovery. We are a comprehensive system of care and a pioneer of health. Read VCU Health Year In Review for more about our accomplishments.