Unknown Company is hiring a Patient Financial Clearance Representative - Ambulatory - Remote

Company is seeking a Patient Financial Clearance Representative - Ambulatory to manage the complete scope of financial clearance activities for assigned patients before their scheduled appointment date. This role is crucial for ensuring efficient clinical workflow and strong revenue cycle operations.

What You'll Do

• Collect and update patient demographic and insurance plan information.
• Verify insurance plan eligibility and benefits using multiple system and web-based tools, and by calling payer and patient as necessary.
• Calculate out-of-pocket liability and collect required deposits, co-pays, deductibles, and outstanding balances from patients prior to service.
• Refer patients to financial counselors when assistance is needed to identify alternate payer source or establish payment plan.
• Contact in-house and community primary care physicians to secure PCP referral for consult and treatment as required by health plan.
• Contact health plan to secure prior authorization for procedures and testing as required.
• Coordinate peer-to-peer reviews between physicians and health plan medical directors to secure prior authorization for services.
• Prepare all forms required to obtain payment from third party payer for services.
• Determine when appropriate to apply additions or revisions to patient account and current visit.
• Maintain thorough knowledge of commercial, managed care, and governmental health care plans.
• Maintain thorough knowledge of insurance plan authorization and referral requirements.

What We're Looking For

• High School Diploma or equivalent.
• 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 and email.
• Strong customer service skills and a patient/customer centered focus in a positive manner in all situations.

Nice to Have

• Post high school education in healthcare or medical billing coursework.
• Previous experience using GE-IDX Patient Registration or other medical billing or registration system.
• Previous experience in ICD and CPT coding.
• Previous experience using medical terminology.

Work Mode

This is a remote position.

Company is an EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.