Financial Clearance Representative I – Clinical Lab Genomic Testing

Role Overview

• Completes insurance verification, eligibility and benefit determination process utilizing integrated electronic eligibility system, payer websites, and phone for all insurance plans within the scope of the patient financial clearance department and assigned service line.
• Interprets and documents the appropriate co-pay, deductible, share of cost, co-insurance, maximum benefit levels and/or available days.
• Contacts patient as appropriate to obtain correct and updated information when necessary.
• Completes Medicare Secondary Questionnaire as appropriate.
• Applies authorization rules and requirements for all payors within the assigned work queues.
• Develops a strong working knowledge of the procedures and diagnosis used in the assigned service-lines to ensure authorizations are properly completed for the scope of services that will be rendered to the patient.
• Assesses the data required for authorization and securing sponsorship.
• Communicates with respective clinics and referring providers to secure appropriate information to complete an authorization.
• Follows up on pending authorization and referral requests to ensure timely completion and secured sponsorship for cases in the assigned work queue.
• Arranges escalation process for clinics and clinicians to complete peer-to-peer appeal reviews with payor utilization management when needed.
• Prioritizes work assigned to them to ensure that financial risk is minimized, and timely completion of authorizations is optimized, while meeting daily productivity measure goals.
• Identifies risk associated with coverage and benefit issues related to the services that are being requested for authorization and escalates these issues to appropriate experts to address.
• Identifies risk associated with securing financial clearance prior to service date and escalates to clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel, sign PAFR).
• Understands the role of financial counseling in securing clearance for cases that do not have authorization secured timely.
• Properly refers these cases as appropriate.
• Notifies the department manager with issues, instances of errors, or obstacles to successful completion of work.
• Applies strong writing skills to account documentation, email communication and internal notes/memos.
• Manages outbound and inbound phone calls.
• Responds promptly to customer inquiries.
• Assists team coordinator and department manager with special projects as needed.
• Serves as a resource for other payor authorization teams.
• Performs other duties and responsibilities as assigned by the Department.

Requirements

• High School diploma or GED equivalent
• One (1) year working knowledge of patient registration and insurance verification and authorization processes in a medical organization
• Epic experience preferred

Benefits

• Equal Opportunity Employer
• Commitment to Providing an Exceptional Patient & Family Experience