Patient Financial Clearance Representative – Ambulatory
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Job Description
Patient Financial Clearance Representative ensuring financial clearance activities and patient responsibility communication before scheduled appointments at VCU Health in Richmond, VA.
Responsibilities:
- Responsible for the entire scope of financial clearance activities for assigned patients before the scheduled appointment date
- Confirm completeness of patient registration data
- Verify insurance eligibility
- Confirm health plan benefits
- Procure PCP referrals and health plan authorizations
- Calculate/collect patient liability estimates
- Communicate patient financial responsibility with consistency, clarity and transparency
- Ensure patients understand the cost of services they receive, their insurance coverage and limitations, and their individual responsibility
- 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 required deposits, co-pays, deductibles, and outstanding balances from patients prior to service
- Refers patients to financial counselors when assistance is needed to identify alternate payer sources
- Contacts health plan to secure prior authorization for procedures/testing
- Coordinates peer-to-peer review between physicians and health plan medical directors to secure prior authorization for services
- Maintains thorough knowledge of commercial, managed care and governmental health care plans
Requirements:
- Minimum three (3) years of previous experience in a health care setting
- Experience in commercial, managed care and governmental health insurance plans
- 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
- Previous experience using GE-IDX Patient Registration or other medical billing/registration system (preferred)
- Previous experience in ICD and CPT coding (preferred)
- Previous experience using medical terminology (preferred)
Benefits:
- N/A
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