What are the responsibilities and job description for the Financial Clearance Representative position at Robert Half?
Job Description
Job Description
We are on the lookout for a Financial Clearance Representative to join our team in the healthcare industry. Based in East Haven, Connecticut, this role offers a long-term contract employment opportunity. As a Financial Clearance Representative, you will be responsible for ensuring the preparedness of payers for reimbursement of scheduled services, obtaining authorizations from payers, and maintaining high-quality customer service.
Responsibilities :
- Ensure the readiness of payers for reimbursement for scheduled services in line with the payer-provider contract.
- Act as a liaison between patients, families, physicians, and their staff, maintaining exceptional levels of customer service.
- Verify patients' insurance and benefits information, notifying relevant staff of any insufficiencies or termination of benefits.
- Use the Epic EMR system for determining insurance eligibility and initial pre-certifications.
- Complete all pre-certification notices prior to admission and initiate the notification process to the insurance company within the set timeframe.
- Obtain necessary approvals and authorizations from third-party payers to ensure accounts can be billed and payment received.
- Determine the medical necessity of scheduled procedures in accordance with Centers for Medicare Medicaid Services (CMS) or other payer standards.
- Communicate coverage / eligibility information to patients.
- Process payments and resolve any discrepancies.
- Take responsibility for obtaining all UB-04 information and ensure compliance with healthcare regulations that govern hospital billing.
- Proven experience in the Healthcare, Hospitals, or Social Assistance industry
- Proficiency in using Epic Electronic Medical Records (EMR) software
- Extensive knowledge in obtaining Prior Authorizations for medical procedures
- Familiarity with Medicare and Medicaid processes and regulations
- Expertise in carrying out Insurance Verifications
- Demonstrated ability in Medical Insurance Verification
- Experience in processing payments in a timely and accurate manner
- Ability to identify and resolve Discrepancies in financial records or reports
- Strong communication and interpersonal skills
- High attention to detail and accuracy
- Ability to maintain confidentiality and adhere to HIPAA guidelines
- Proficient in using Microsoft Office Suite (Word, Excel, Outlook)
- Ability to work in a fast-paced environment and handle multiple tasks simultaneously
- Excellent problem-solving skills and the ability to make decisions under pressure
- Strong understanding of medical terminology and coding.
