Patient Financial Clearance Representative I

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct insurance verification, eligibility checks, and benefit assessments utilizing electronic eligibility systems, payer websites, and phone communications.

• Analyze and record details related to co-pays, deductibles, co-insurance, maximum benefit limits, and available days.

• Reach out to patients to gather and update necessary information.

• Complete Medicare Secondary Questionnaires as needed.

• Implement authorization protocols and requirements for designated payors and manage work queues effectively.

• Acquire knowledge of procedures and diagnoses relevant to assigned service lines for the completion of authorizations.

• Evaluate essential data and liaise with clinics and referring providers to obtain authorization information.

• Follow up on outstanding authorization and referral requests.

• Organize peer-to-peer appeal reviews with payor utilization management as required.

• Prioritize tasks to mitigate financial risk, ensure timely completion of authorizations, and achieve productivity objectives.

• Recognize and escalate issues related to coverage, benefits, and financial clearance risks.

• Refer cases to financial counseling when appropriate.

• Inform management of errors or challenges encountered.

• Maintain account documentation and prepare email communications and internal notes/memos.

• Handle inbound and outbound phone calls while addressing customer inquiries.

• Assist with special projects and act as a resource for other payor authorization teams.

• Perform additional assigned tasks.

⛳️ Requirements

• High School diploma or GED equivalent.

• A minimum of one (1) year of experience in patient registration, insurance verification, and authorization processes within a medical organization.

• Epic experience is preferred.

🏝️ Benefits

• Comprehensive health insurance.

• Retirement savings plan with employer contribution.

• Opportunities for professional development and career advancement.

• Flexible work schedules.