Financial Clearance Representative - Behavioral

Job Overview

Job Summary:

This position is responsible for completing the financial clearance process within Mental Health and Addiction Patient Access for acute inpatient hospitalizations, routine outpatient evaluations, and routine mental health care authorizations. This is a higher-level position in the FSC that requires understanding of and working with multiple insurance payors to secure benefits and increase the likelihood of reimbursement for Fairview at the highest benefit level.

The Financial Clearance Rep (FCR) makes the decision when and how to work with psychiatry providers, insurance payors and other external sources to assist families in obtaining healthcare and financial services.

Job Expectations:

Registration:

Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration of patients. Ensures that proper insurance payor plan choice and billing address are assigned in the automated patient accounting system. Verify relevant group/ID numbers as well as ensuring the proper behavioral account is attached to each hospital account record (HAR) to ensure payment for services.

Financial Screening:

The FCR must be able to effectively articulate payor information in a manner such that patients, guarantors, and family members gain a clear understanding of their financial responsibilities.

The FCR will be responsible for completing the insurance and benefits verification to determine the patient's benefit level. They will screen payor medical policies to determine if the scheduled procedure meets medical necessity guidelines, submit, and manage referrals and authorization requests/requirements when necessary, and/or ensure that pre-certification and admissions notification requirements, both inpatient and outpatient, are met per payor guidelines. They will provide support and process prior authorization appeals and denials, when necessary, in conjunction with revenue cycle and clinical staff.

Verifies insurance eligibility. Completes automated insurance eligibility verification, when applicable and appropriately documents information in Fairview's patient accounting system.

Determines the patient's insurance type and educates patients regarding coverage and/or coverage issues and ensures the proper behavioral payer account is uploaded to ensure reimbursement and reduce denials.

Informs families, providers, and behavioral Utilization Management teams with inadequate insurance coverage regarding financial assistance through government and Fairview financial assistance programs. Performs initial financial screening and refers accounts for financial counseling.

Initiates treatment authorization requests and pursues referrals per payor guidelines. Reviews medical chart/history and physician order(s) to determine likely ICD and CPT codes that are billable services for the appropriate level of care.

Reviews payor medical policies to determine if procedures meet medical necessity guidelines.

Works with behavioral Utilization Management teams, mental health providers, clinics and ancillary service departments if medical necessity fails.

Follow up with insurance payors on prior authorization denials. Process authorization denial appeals, when necessary.

Point of Service Collection:

Educates patients and attempts to collect co-payments, co-insurance, and deductibles per Fairview's POS collections policies and procedures.

Organization Expectations, as applicable:

• Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served
  • Partners with patient care giver in care/decision making.
  • Communicates in a respective manner.
  • Ensures a safe, secure environment.
  • Individualizes plan of care to meet patient needs.
  • Modifies clinical interventions based on population served.
  • Provides patient education based on as assessment of learning needs of patient/care giver.
• Fulfills all organizational requirements
  • Completes all required learning relevant to the role
  • Complies with and maintains knowledge of all relevant laws, regulations, policies, procedures, and standards.
• Fosters a culture of improvement, efficiency, and innovative thinking.
• Performs other duties as assigned

Minimum Qualifications to Fulfill Job Responsibilities:

Required

Experience

• Four (4) years' experience working in revenue cycle, insurance verification/eligibility, financial securing, or related areas. Experience with practice management software, hospital billing software or electronic health record software.
• Or, two (2) years' experience working in revenue cycle, insurance verification/eligibility, financial securing, or related areas in combination with an Associate degree in Healthcare related field.

Preferred

Education

• Healthcare related AA

Experience

• Prior Authorization Experience
• Previous Epic experience
• 1 year in a mental health setting

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link foradditional information:


Compensation Disclaimer

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.


EEO Statement

EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status