Apply on Employer Site

Stanford Health Care · 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 exp

Stanford Health Care is seeking a Patient Financial Clearance Representative to perform specialized functions related to insurance verification and securing authorization for patients. The role involves completing insurance eligibility processes, communicating with patients and providers, and ensuring timely completion of authorizations while minimizing financial risk.

Health CareHealth DiagnosticsHospitalMedicalPrimary and Urgent Care

Comp. & Benefits

H1B Sponsor Likely

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

Insurance verificationAuthorization processesHealthcare payer knowledgeEpic experiencePatient registrationCustomer serviceWriting skills

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

Company

Stanford Health Care

Glassdoor4.0

Stanford Health Care is a healthcare center that treats cancer, heart disease, brain disorders, and primary care issues.

Founded in 1885

Palo Alto, California, USA

10001+ employees

https://stanfordhealthcare.org

H1B Sponsorship

Stanford Health Care has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (102)

2024 (74)

2023 (82)

2022 (55)

2021 (54)

2020 (67)