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AI Summary
Job Summary
Under the direction of the Director, of Financial Clearance, the Financial Clearance Rep is responsible for ensuring accounts are financially cleared prior to the date of service. Financial Clearance Reps are responsible for interviewing patients when they are scheduled to come into the hospital either for an elective outpatient, scheduled surgery or outpatient procedure.
Essential Functions
Perform all Financial Clearance duties to ensure the account is financially cleared prior to service. The Financial Clearance Rep is responsible for gathering demographic information (i.e. name, address, phone number, social security number, type of insurance coverage, etc.) about the patient. This key position begins the overall patient's experience and starts the billing process for any services provided by the hospital. This position is responsible for obtaining and verifying accurate insurance information, benefit validation, authorization and pre-service collections.
Financially clears patients for each visit type, admit type and area of service via EPIC (Electronic Medical Record- EMR). Collects and documents all required demographic and financial information. Appropriately activates registration and discharges in a timely fashion.
Accurately and efficiently performs registration and financial functions to include: thorough interviewing techniques, pre-registers patients in appropriate status, follows pre-registration guidelines while ensuring the accurate and timely documentation of demographic and financial data. Analyze patient insurance(s), identifies the correct insurance plan, selects appropriately from EPIC insurance and plan selections and documents correct insurance order. Applies recurring visit processing according to protocol. May facilitate use of electronic registration tools where available (credit card processing, etc.).
Verifies patient information with third party payers. Collects insurance referrals and documents within EPIC. Communicates with patients and physician/offices regarding authorization/referral requirements. Obtains financial responsibility forms or completed electronic forms with patients as necessary.
Screens outpatient visits for medical necessity. Provides cost estimates. Collects and documents Medicare Questionnaire and obtains information from the patient if third party payers need to be billed (i.e. worker's compensation, motor vehicle accidents and any other applicable payer). Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans. Ensures Meaningful Use requirements are met as appropriate.
Financial Advocacy: Screens all patients self-pay & out of network patients using approved technology. Provides information for follow up and referral to the Benefit Advisor as appropriate. Initiates payment plans and obtains payment. Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family. Incorporates point of service (POS) collection processes into daily functions.
Collects CPT and ICD-10 codes. Performs medical necessity check and prepares ABN as appropriate for Medicare primary outpatients.
Manages/prepares miscellaneous reports, schedules and paperwork. Maintains inventory of supplies.
Maintains and exceeds the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection and standards for registrations/insurance verification.
Qualifications
Required
High School Diploma or equivalent
CRT-Revenue Cycle Representative, Certified (CRCR) - HFMA Healthcare Financial Management Association 1 Year
Preferred
Associate's Degree or Bachelor's degree in business, management or other related fields.
1 year of relevant experience in a customer service role or health care industry.
About Corewell Health
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Corewell Health Southfield Center - 26901 Beaumont BlvdDepartment Name
Contact Center Pre Authorizations - CorporateEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8 a.m. to 4:30 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
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