[Hiring] Financial Clearance Representative Lead @UnitedHealth Group

Role Description

The Financial Clearance Representative Lead is responsible for completing the financial clearance process and creating the first impression of Allina’s services to patients, their families, and other external customers. Must be able to articulate information in a manner that patients, guarantors, and family members understand and will know what to expect regarding their financial responsibilities. Works with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial services. Functions as a subject matter expert for the department. Coaches and mentors experienced staff on all aspects of financial clearance.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Perform financial clearance processes by interviewing patients and collecting and recording all necessary information for pre-registration of patients.
• Educate patients of pertinent policies as necessary i.e., Patient Rights, HIPAA information, consents for treatment, visiting hours, etc.
• Verify insurance eligibility and complete automated insurance eligibility verification, when applicable, and appropriately document information in Epic.
• Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure.
• Confirm what benefits of a patient’s upcoming visit/stay are covered by the patient’s insurance(s) including exact coverage, effective date of the policy, coverage limitations/requirements, and patient liabilities for the type of service(s) provided.
• Provide proactive price estimates and work with patients so they understand their financial responsibilities.
• Inform families with inadequate insurance coverage of financial assistance through government and financial assistance programs and refer the patient to financial counseling.
• Review and analyze patient visit information to determine whether authorization is needed and understand payor specific criteria to appropriately secure authorization and clear the account prior to service where possible.
• Ensure that initial and all subsequent authorizations are obtained in a timely manner.
• Provide mentoring and daily workflow coaching to less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role.
• Perform Enhanced Financial Clearance activities:
• May complete admission reviews for hospital admissions to support the authorization process.
• May complete notification of hospital admission and discharge for hospital admissions.
• Expanded insurance benefit review for more complex and/or high dollar procedures.
• Perform financial counseling with patients; includes evaluating assistance programs the patient may qualify for, completing applications, determining the need for delay/cancel of services and escalating as needed.
• May be assigned to work special projects and/or non-standard workflows.
• Organize and coordinate Financial Clearance team activities:
• Provide day-to-day work assignments, oversight and leadership to staff.
• Work with the department Supervisor to set standards, develop and execute improvement plans.
• Alert Supervisor of any backlogs and provide suggestions for resolution.
• Communicate issues that need management attention and/or identify areas where staff, process, or performance improvements are needed to Supervisor.
• Review and resolve accounts that are complex and require a higher degree of expertise and critical thinking.
• Participate in the orientation and training of employees and provide feedback to leadership.
• Perform daily accuracy reports and quality assurance reviews of patient accounts as directed.
• May act as a back-up for work within the department.
• Other duties as assigned.

Qualifications

• 4+ years of experience with Insurance and/or Benefit Verification activities in healthcare business office/insurance operations.
• 1+ years of experience as a Financial Clearance Representative.
• Ability to work Monday – Friday – 7 AM – 3:30 PM CST.
• Must be 18 years of age OR older.

Requirements

• Associate's or Vocational degree in Business Administration, Health Care Administration, Public Health, or Related Field of Study (preferred).
• Experience working with clinical staff (preferred).
• Previous experience working in outpatient and/or inpatient healthcare settings (preferred).
• Experience working in clinical documentation (preferred).
• Previous experience working with a patient’s clinical medical record (preferred).

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
• 401(k) Savings Plan, Employee Stock Purchase Plan.
• Education Reimbursement.
• Employee Discounts.
• Employee Assistance Program.
• Employee Referral Bonus Program.
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).