Patient Financial Clearance Specialist

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency. • Use work queues within the EPIC system to coordinate all financial clearance work. Keep the WQ’s current and within the required compliance of the NSA. • Follow up with patient, insurance, or provider/department if there are insurance coverage issues for resolution. • Maintains current knowledge of major payer payment provisions and regulations. • Assists Patient Financial Services with denial management issues as needed. • Coordinates and assists in the preparation and gathering of summaries, databases, statistical tables, requisitions or special reports, and other data gathering for review by leader. • Maintains work queue volumes and productivity within established guidelines in order to provide accurate/timely estimates to patients in a manner conducive to the success of WVUM. This will include regular contact with the patient to discuss the estimate and collect any payments needed. • Develop tools (e.g. checklists) and observe revenue cycle front-end processes and documents results of gaps for leadership team. Assist with all team objectives to improve the success of the FCT (Financial Clearance Team) by collaborating routinely to help in the success of the department. • Communicates found errors to the responsible area and the leadership team and trainer(s) to make sure that training gaps are corrected.

🎯 Requirements

• High school graduate or GED. • State criminal background check and Federal (if applicable), as required for regulated areas. • Two (2) years’ experience in revenue cycle or customer service related role. • Associate degree in a related medical field such as medical assisting or medical office administration is preferred. • HFMA Certified Revenue Cycle Representative (CRCR) or similar revenue cycle certification. • NAHAM Certified Healthcare Access Associate or similar revenue cycle certification. • Knowledge of healthcare insurance plans, coverages and understanding a patient (OOP) out of pocket costs with the ability to communicate that information to the patient, and general knowledge of hospital clinical departments and service protocols. • Self-motivated, problem solving, analytical insurance expert with previous clinical working knowledge of testing workflow along with critical thinking ability. • Thorough understanding and working knowledge of CPT codes, medical terminology, ability to read and explain back EOB for all insurance types; excellent interpersonal, verbal, and written communication; excellent organizational, analytical; excellent time management and multi-tasking abilities.

🏖️ Benefits

• Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information. • Participate in the processes to assess and improve the services provided and compliance with regulatory requirements. • Complies with Notices of Privacy Practices, and the Patient’s Rights and Responsibilities and cooperate with the WVUH Corporate Compliance Program during employment. • Directs patients needing financial assistance to speak with a Financial Counselor. • May obtain demographic/billing/insurance information from patients/family/legal guardian and enter into the registration/billing systems for service and claim processing. • Responds daily to telephone or email inquiries and performs appropriate actions; Documents all actions taken in the appropriate locations; Serves as a resource to staff and patients for insurance related issues; Knowledge of current contracted and non-contracted insurance plans; Follows through and makes corrections in demos and insurances as they are discovered. • Takes payments as appropriate via the standard protocol for processing the payment fully via the billing system. • Be available to handle inquiries via the Jabber, call center environment with the FCT, which includes timely responses and follow up as needed.