[Remote] Patient Financial Clearance Representative - Remote

Note: The job is a remote job and is open to candidates in USA. VCU Health is seeking a Patient Financial Clearance Representative to support insurance and registration processes within their Ambulatory Business Operations. The role is responsible for managing financial clearance activities for patients, ensuring they understand their financial responsibilities and insurance coverage prior to appointments.

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

Skills

• Minimum three (3) years of previous experience in a health care setting to include: 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
• High School Diploma or equivalent
• Previous experience using EPIC Patient Registration or other medical billing/registration system
• Previous experience in ICD and CPT coding
• Previous experience using medical terminology
• Post high school education in healthcare or medical billing coursework

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