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VitalConnect · 1 day ago

Intake Specialist

United States

Full-time

Remote

Entry Level

$22/hr - $24/hr

1+ years exp

VitalConnect is a company focused on healthcare solutions, and they are seeking an Intake Financial Clearance Specialist. This role is responsible for coordinating financial clearance activities, ensuring timely access to care, and maximizing reimbursement by interacting with various stakeholders involved in the financial clearance process.

BiotechnologyHealth CareMedical DeviceWearables

Diversity & Inclusion

Responsibilities

Monitors accounts routed to registration, referral and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines

Maintains knowledge of and complies with insurance companies' requirements for obtaining prior authorizations/referrals and completes other activities to facilitate all aspects of financial clearance

Acts as subject matter experts in navigating payer policies to get the appropriate approvals (authorizations, pre-certs, referrals, for example) for the ordered services to proceed. The Intake Financial Clearance Specialist is an important part of the larger patient care team and helps clinicians understand what payer requirements are necessary for the widest possible patient access to services

Supports staff at all levels for hands-on help understanding and navigating financial clearance issues

Uses appropriate strategies to underscore the most efficient process to obtaining insurance verification, authorizations, and referrals, including online databases, electronic correspondence, faxes, and phone calls

Obtains and clearly documents all referral/prior authorizations for scheduled services

Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients, and any other parties to ensure that required managed care referrals and prior authorizations are obtained and appropriately recorded in the relevant systems

When it is determined that a valid referral does not exist, utilize computer-based tools, or contact the appropriate party to obtain/generate referral/authorization and related information. Record the referral/authorization in the practice management system

Contact physicians to obtain referral/authorization numbers

Perform follow-up activities indicated by relevant management reports

Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients' scheduled services

Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations

Work collaboratively with the practices to resolve registration, insurance verification, referral, or authorization issue to the extent that these unresolved issues impact the ability to obtain a referral/authorization

Escalates accounts that have been denied or will not be financially cleared as outlined by department policy

Accept registration updates from various intake points, including but not limited to those received via paper forms, internet registration forms, telephones located in practices and direct calls from patients

Ensure that all updated demographic and insurance information is accurately recorded in the appropriate registration systems for primary, secondary, and tertiary insurances

Review all registration and insurance information in systems and reconcile with information available from insurance carriers. For any insurance updates, utilize any available resources to validate the updated insurance information, insurance plan eligibility, primary care physician, subscriber information, employer information and appointment/visit information. Contact patients as necessary if clarifications or other follow-up is required, and at all times maintain sensitivity and a clear customer friendly approach

For self-pay patients or patients with unresolved insurance, and for financial counseling, refer patients Patient Financial Counseling

Maintains confidentiality of patient's financial and medical records; adheres to the State and Federal laws regulating collection in healthcare; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately

Demonstrates knowledge & skills necessary to provide level of customer experience as aligned with BMC management expectations

Demonstrates the ability to recognize situations that require escalation to the Supervisor

Establishes relationships and effectively collaborates with revenue cycle staff to support continuous improvement aligned with management expectations as outlined

Takes opportunity to know and learn other roles and processes and works together to assist with process improvement initiatives as directed

Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities

Handle telephone calls in a timely fashion, following applicable scripting and customer service standards. Appropriately manage all calls by either working with the customer or referring the call to the appropriate party

Communicate with all internal and external customers effectively and courteously

Maintain patient confidentiality, including but not limited to, compliance with HIPAA

Perform other related duties as assigned or required

Qualification

Insurance knowledgeCustomer service skillsHealthcare terminologyCPT-ICD10 codesMicrosoft SuiteInterpersonal skillsVerbal communicationAttention to detail

Required

High School Diploma or GED required

1-3 years patient registration and/or Insurance experience desirable

At least one year of experience must be in a customer service role

General knowledge of healthcare terminology and CPT-ICD10 codes

Complete understanding of insurance is required

Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues

Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers

Able to communicate effectively in writing

Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view

Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail

Must be able to maintain strict confidentiality of all personal/health sensitive information

Ability to effectively handle challenging situations and to balance multiple priorities

Basic computer proficiency inclusive of ability to access, enter and interpret computerized data/information including proficiency in Microsoft Suite applications, specifically Excel, Word, Outlook and Zoom

Displays a thorough knowledge of various sections within the work unit to provide assistance and back-up coverage as directed

Displays a deep understanding of Revenue Cycle processes and applies knowledge to meet and maintain productivity standards as outlined by Management