Patient Financial Clearance Specialist

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The Patient Financial Clearance Specialist is responsible for producing and sharing accurate and timely service estimates (GFE - Good Faith Estimates) to all scheduled patients in addition to verification of insurance and benefit information. This position will project a mature problem-solving attitude with an ability to handle multiple tasks and be flexible and work with minimal supervision. Maintains knowledge of revenue cycle operations, CMS No Surprises Act (NSA) regulations, and compliance requirements, third party reimbursement, local/state/federal regulations, and medical terminology. Exceptional knowledge of CPT codes and procedures is needed. Provides excellent customer service and uses strong written/verbal communication skills, that will be used when communicating the patients out of pocket expenses.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.High school graduate or GED.

2.West Virginia state criminal background check required and Federal, if applicable, for DHHR BMS regulated area(s).

EXPERIENCE:

1.Two (2) years' experience in revenue cycle or customer service related role.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.Associate degree in a related medical field such as medical assisting or medical office administration is preferred.

2.HFMA Certified Revenue Cycle Representative (CRCR) or similar revenue cycle certification.

3.NAHAM Certified Healthcare Access Associate or similar revenue cycle certification.

4.Knowledge of healthcare insurance plans, coverages and understanding a patient (OOP) out of pocket costs with the ability to communicate that information to the patient, and general knowledge of hospital clinical departments and service protocols. Self-motivated, problem solving, analytical insurance expert with previous clinical working knowledge of testing workflow along with critical thinking ability.

5.Thorough understanding and working knowledge of CPT codes, medical terminology, ability to read and explain back EOB for all insurance types; excellent interpersonal, verbal, and written communication; excellent organizational, analytical; excellent time management and multi-tasking abilities.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1.Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency.

2.Use work queues within the EPIC system to coordinate all financial clearance work. Keep the WQ's current and within the required compliance of the NSA.

3.Follow up with patient, insurance, or provider/department if there are insurance coverage issues for resolution.

4.Maintains current knowledge of major payer payment provisions and regulations.

5.Assists Patient Financial Services with denial management issues as needed.

6.Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information.

7.Coordinates and assists in the preparation and gathering of summaries, databases, statistical tables, requisitions or special reports, and other data gathering for review by leader.

8.Maintains work queue volumes and productivity within established guidelines in order to provide accurate/timely estimates to patients in a manner conducive to the success of WVUM. This will include regular contact with the patient to discuss the estimate and collect any payments needed.

9 Develop tools (e.g. checklists) and observe revenue cycle front-end processes and documents results of gaps for leadership team. Assist with all team objectives to improve the success of the FCT (Financial Clearance Team) by collaborating routinely to help in the success of the department.

10 Communicates found errors to the responsible area and the leadership team and trainer(s) to make sure that training gaps are corrected.

11 Documents accounts clearly and accurately with all activity completed on every account. Always reviews the activity and notes on the account prior to proceeding with any given activity or research, to clarify the status of the account activity prior.

12. Maintains positive working relationships with internal departments and peers across the health system such as Patient Financial Services, Coding, HIM, Accounting, physician offices and staff, clinics, Financial Counselors, etc.

13. Utilizes payer websites, payer phone numbers, eligibility websites, and other software as warranted to verify coverage eligibility and benefits for date of service(s). Adds insurance as appropriate for coverage found.

14. Remains current and responsive to changes in healthcare delivery, standards established by professional organizations, regulatory and accrediting bodies, and the needs of the organizations.

15. Complies with annual competency requirements related to Emergency Preparedness, hazards, blood borne pathogens, universal precautions, infection control, electrical/fire safety, material safety data sheets and any other topic deemed appropriate to assigned work areas.

16. Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results of assessments and improvement processes to the appropriate administrative levels.

17. Complies with Notices of Privacy Practices, and the Patient's Rights and Responsibilities and cooperate with the WVUH Corporate Compliance Program during employment.

18. Directs patients needing financial assistance to speak with a Financial Counselor.

19. May obtain demographic/billing/insurance information from patient/family/legal guardian and enter into the registration/billing systems for service and claim processing.

20. Responds daily to telephone or email inquiries and performs appropriate actions; Documents all actions taken in the appropriate locations; Serves as a resource to staff and patients for insurance related issues; Knowledge of current contracted and non-contracted insurance plans; Follows through and makes corrections in demos and insurances as they are discovered.

21. Takes payments as appropriate via the standard protocol for processing the payment fully via the billing system.

22. Be available to handle inquiries via the Jabber, call center environment with the FCT, which includes timely responses and follow up as needed.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing duties throughout the work shift.

2.Must be able to read and write legibly in English.

3.Visual acuity must be within normal range.

4.Must be able to exert in excess of 50 pounds of force occasionally, and/or up to 25 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.

5.Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.

6.Must have the ability to move throughout the work area and clinic area.

7.Must be able to sit or stand for extended periods of time. The position is currently a remote, work from home position.

8.Must have reading and comprehension ability.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Must be capable of performing assigned task despite frequent interruptions.

2.Must be capable of working within a confined office space and under fluorescent lighting.

3.Must have ability to maintain concentration in and around noise from office machinery such as a copier or printer.

4.High volume, fast paced environment.

5.Exposure to communicable disease.

6.Interacts with patients, medical staff, and support staff daily on a continual basis.

SKILLS AND ABILITIES:

1.Ability to accurately utilize applicable computer software and equipment for access processing & demonstrates ability to follow down time procedures.

2.Demonstrate knowledge of procedure to report and/or document unsafe/hazardous conditions, incidents, and defective equipment in compliance with hospital policy.

3.Requires ability to perform repetitious duties throughout the shift.

4.Requires considerable attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

5.Requires the ability to memorize a considerable amount of information, and to be able to reference information not retained from written sources or from appropriate personnel.

6.Requires the ability to understand medical insurance requirements for payment and basic knowledge of covered services.

7.Must be able to work with a variety of personality types and interact with individuals with various levels of education, capabilities and communication skills.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

535 SYSTEM Centralized Clearance Center

Address:

Morgantown WV

Core

West Virginia