Financial Clearance Rep - Rehab

We are seeking a financial clearance rep (FCR) to join our rehab services team!

The FCR must be able to effectively articulate payor information in a manner such that therapists, patients and families gain a clear understanding of financial responsibilities.The FCR will be responsible for completing the insurance and benefits verification to determine the patient’s benefit level for outpatient therapy services including physical, occupational, speech, cardiac, pulmonary, and hearing aids/audiology. They will obtain benefit levels, screen payor medical policies to determine if the scheduled procedure meets medical necessity guidelines, submit and manage referral and authorization requests/requirements when necessary, and/or ensure that pre-certification notification requirements 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. The FCR makes the decision when and how to work with providers, clinical staff, insurance payors and other external sources to assist in obtaining healthcare benefits.

• FTE 1.0, authorized for 80 hours per pay period.
• Schedule: Monday-Friday, 8:30am - 5:00pm.
• Remote position.
• Full benefits such as medical, HSA, dental insurance, vision insurance, 403b, PTO, health & wellbeing resources, Health & Wellness funding, and more!

M Health Fairview Rehabilitation offers a broad range of services that serve patients across 10 acute-care hospitals, 3 post-acute settings and 70 outpatient adult and pediatric therapy clinics. Consisting of Physical, Occupational and Speech Therapy as well as Audiology and Cardiac & Pulmonary Rehab, our therapists collaborate with colleagues in all medical settings and offer dozens of specialty programs.

As an academic health system with residency and fellowship programs and a rehab-focused clinical quality team, we have a collaborative culture that is centered on learning with an emphasis on evidence based, patient-centered care. Rehab’s continuing education program offers continuing education courses per year at no cost to employees.

Responsibilities

• Practice excellent telephone etiquette and active listening skills.
• Identify insurances for all new patients that require information/notification from the site for new, continuing, and observation patients.
• Document and track all communication with insurers, clinic staff, and patients.
• Document each step taken in the process of acquiring benefits, prior authorization, or confirmation compensability determination.
• Document pertinent information for therapist use in contacting insurance carrier if further authorization is necessary.
• Enters referrals with all pertinent information into Epic referral entry.
• Initiate process to establish company account for worker’s compensation patients and all other insurances as needed.
• Informs patients/clinic/caregiver of denials by insurance companies when pre-authorizing services.
• Contact patients with insurance issues such as termed insurance, out of network, no rehab benefits.
• Develop a list of key contacts at insurance companies and develop positive working relationships to facilitate ability to retro-authorize claims and increase reimbursement.
• Assist in training new insurance staff
• Acquire insurance referrals from PCC, if required by insurance.
• Submit appeals to insurances for prior authorization, if needed.
• Incorporate new changes in insurance verification and adapt to changes in volume of workload.

Required Qualifications

• 1 year experience in insurance verification/eligibility, financial securing or related areas. 
• Experience with electronic health record software. 

Preferred Qualifications

• Associate of Science
• Vocational/Technical Training
• Epic experience
• Insurance/benefit verification experience
• Referrals and/or prior authorization experience
• Knowledge of medical terminology and clinical documentation review
• 2 years of experience working insurance/benefit verification, financial securing, or related areas using an EHR in a healthcare organization
• Knowledge of computer system applications, including Microsoft Office 365

$22.96- $32.42 Hourly