Patient Access Representative, Financial Clearance

Patient Access Representative, Financial Clearance

The Patient Access Representative, Financial Clearance, supporting pre-registration services located in Commack, NY, is a key member of the Patient Access Services team. Acts as quality control for inpatient elective accounts, outpatient surgeries and ancillary hospital services, ensuring all pertinent demographic and insurance information is identified and accurately documented, supporting timely and efficient billing. Secures financial clearance through insurance verification, and authorization/referral validation. Communicates with multiple clinical and operational departments, ensuring documentation of third-party review registrations are complete and meet financial clearance criteria prior to service. Supports the registration areas with financial services expertise. Patient Access Representatives are responsible for completing varied, diverse and specialized duties to support the Revenue Cycle, Compliance and Patient Experience by accurately and efficiently completing tasks in areas of Registration, Financial Screening and Verification, and patient throughput. Qualified candidates will demonstrate excellent communication and interpersonal skills, knowledge and understanding of patient care and effectively respond to changing patient needs by making decisions based on ethical principles and adhering to our high standard of excellence.

Duties of a Patient Access Financial Clearance Representative may include but, are not limited to the following:

• Follows policy and procedure in regard to financial screening, investigation, referral authorization requirements and patient cost sharing for all scheduled hospital elective services.
• Verifies and assures all insurance coverage is active and confirms eligibility and benefits for specific service, validates proper authorization is secured for appropriate procedure, diagnoses and service location.
• Clearly documents notes regarding financial clearance process.
• Serves as support to patients and their family members to assure patients have access to all available financial assistance resources.
• Maintains daily contact with Utilization Management, Business office, patient registration, ancillary departments as well as physician offices to ensure all registration information is accurate and financial clearance requirements are met prior to scheduled elective services.
• Contacts referring/ordering provider in a timely manner to initiate or complete payor requirements to secure authorization approval prior to scheduled procedure.
• Utilizes computer systems/software used by the registration/scheduling department and maintains competence in policy benefit and nuisances, actively utilizes insurance web sites and other communication with insurers as required to ensure payment and patient financial care.
• Provides financial guidance and excellence in Financial Care to patients and their representatives by providing information about their health care insurance coverage and cost share responsibilities.
• Ensures compliance with HIPAA regulations, payor guidelines and healthcare industry standards.
• Utilizing various work lists, monitor and ensure registration workflow and financial clearance process is complete within prescribed time frames.
• Demonstrates a positive organizational attitude and commitment to patient experience. Maintains respectful and compassionate demeanor and provides high-quality patient centered care.

The selected candidate will be required to work some holidays.

Qualifications Required:

A minimum of an Associate's degree and at least 1 year of experience working in a hospital, physician practice, or healthcare setting in revenue cycle, patient access, financial counseling or insurance authorizations. or in lieu of degree, at least 2 years of demonstrated experience in revenue cycle, patient access, financial counseling, or insurance authorizations. Strong background in medical insurance verification, benefits investigation, and authorization management. Extensive knowledge of commercial insurance, Medicare, Medicaid, managed care plans, workers' compensation, and government-funded insurance programs. Skilled in interpreting insurance benefits, medical necessity requirements, and payer-specific policies. Experience with electronic health records (EHR), practice management software, and insurance portals. Knowledge of CPT, ICD-10, and HCPCS coding related to authorization and insurance verification. Excellent analytical, organizational, and customer service skills with the ability to manage high-volume workloads while maintaining accuracy. Proven ability to resolve complex insurance issues, reduce authorization turnaround times, and improve reimbursement outcomes.

Preferred Quals:

Billing experience and an understanding of Accounts Receivables. Previous experience as a Patient Access Representative in a medical center or hospital preferred.

Please Note: Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.