Stanford Health Care Tri-Valley · 1 day ago
Patient Financial Clearance Rep I - Clin Lab Genomic Testing Multi Site - Full Time, Day - 08 hrs
United States
Full-time
Remote
Entry Level
$33.89/hr - $38.15/hr
1+ years expStanford Health Care Tri-Valley is seeking a Patient Financial Clearance Representative to perform specialized functions related to insurance verification and securing authorizations for patients. The role involves completing insurance verification processes, interpreting co-pay and deductible information, and ensuring timely completion of authorizations while minimizing financial risk.
Health CareHospitalNon Profit
Responsibilities
Completes insurance verification, eligibility and benefit determination process utilizing integrated electronic eligibility system, payer websites, and phone for all insurance plans within the scope of the patient financial clearance department and assigned service line
Interprets and documents the appropriate co-pay, deductible, share of cost, co-insurance, maximum benefit levels and/or available days
Contacts patient as appropriate to obtain correct and updated information when necessary
Completes Medicare Secondary Questionnaire as appropriate
Applies authorization rules and requirements for all payors within the assigned work queues
Develops a strong working knowledge of the procedures and diagnosis used in the assigned service-lines to ensure authorizations are properly completed for the scope of services that will be rendered to the patient
Assesses the data required for authorization and securing sponsorship. Communicates with respective clinics and referring providers to secure appropriate information to complete an authorization
Follows up on pending authorization and referral requests to ensure timely completion and secured sponsorship for cases in the assigned work queue
Arranges escalation process for clinics and clinicians to complete peer-to-peer appeal reviews with payor utilization management when needed
Prioritizes work assigned to them to ensure that financial risk is minimized, and timely completion of authorizations is optimized, while meeting daily productivity measure goals
Identifies risk associated with coverage and benefit issues related to the services that are being requested for authorization and escalates these issues to appropriate experts to address
Identifies risk associated with securing financial clearance prior to service date and escalates to clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel, sign PAFR)
Understands the role of financial counseling in securing clearance for cases that do not have authorization secured timely. Properly refers these cases as appropriate
Notifies the department manager with issues, instances of errors, or obstacles to successful completion of work
Applies strong writing skills to account documentation, email communication and internal notes/memos
Manages outbound and inbound phone calls
Responds promptly to customer inquiries
Assists team coordinator and department manager with special projects as needed
Serves as a resource for other payor authorization teams
Performs other duties and responsibilities as assigned by the Department
Qualification
Required
High School diploma or GED equivalent
One (1) year working knowledge of patient registration and insurance verification and authorization processes in a medical organization
Preferred
Epic experience preferred
Company
Stanford Health Care Tri-Valley
STANFORD HEALTH CARE TRI-VALLEY Stanford Health Care Tri-Valley (formerly ValleyCare) provides high-quality care rooted in science and compassion to support the health and well-being of its community in the East Bay and beyond.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Reena Jadhav
Board Member, Chair Comp & Workforce
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