REMOTE Financial Clearance II

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* Employment Type:

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* Full time

** Shift:*
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* Description:

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* ** POSITION PURPOSE*
* Responsible for ensuring all pre-service accounts are financially cleared and secured prior to the date of service for Trinity Health. Responsible for complex, high dollar services including surgical, observation and in-house services.  Performs work in the multiple areas of verification:
Outpatient verification, Elective Short Procedure/Inpatient verification, Urgent Admission verification or Scheduling and is responsible for obtaining and verifying accurate insurance information, benefit validation, authorization, and preservice collections. This is a key position that begins the overall patient experience and initiates the billing process for any services provided by the hospital.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

** ESSENTIAL FUNCTIONS*
* Responsible for financially clearing patients for each visit type, admit type and area of service via current HIS (Health Information System). Collects and documents all required demographic and financial information. Activates registration and discharges in an appropriate and timely fashion.

Coordinates with Care Management for level of care, Medicare Inpatient Only list, and required authorizations.

Coordinates with OR Scheduling on date of service changes and/or other revisions or cancellations and processes accordingly.

Analyzes patient insurance(s), identifies the correct insurance plan, selects appropriately from HIS insurance and plan selections and documents correct insurance order.  Applies recurring visit processing according to protocol.

Verifies patient information with third party payers. Collects insurance referrals and documents within HIS. Communicates with patients and physician/offices regarding authorization/referral requirements. Identifies potential need for financial responsibility forms or completed electronic forms with patients as necessary. Escalates accounts appropriately in accordance with department Defer/Delay policy to manager.

Screens outpatient visits for medical necessity and issues Advanced Beneficiary Notice as appropriate for Medicare primary outpatients. Provides cost estimates.  Collects and documents Medicare Secondary Payer Questionnaire (MSPQ) and obtains information from the patient if third party payers need to be billed (i.e., worker's compensation, motor vehicle accidents and any other applicable payer).

Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans.  Ensures Meaningful Use requirements are met as appropriate.

Screens all patients self-pay & out of network patients using approved technology.  Provides information for follow up and referral to the RHM Medicaid Vendor and/or Financial Counselor as appropriate. Initiates payment plans and obtains payment.  Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family.  Incorporates point of service (POS) collection processes into daily functions.

May issue receipts and complete cash balance sheets in specified areas where appropriate.  Utilizes audits and controls to manage cash accurately and safely.

Maintains and exceeds the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection, and standards for registrations/insurance verification

Coordinates timely and accurate appointment scheduling across the region with expertise in scheduling protocols, insurance requirements and accurate collection and verification of pre-registration needs on an as needed basis

Communicates and promptly escalates accounts of concern to management.

Must possess the ability to comply with Trinity Health policies and procedures.  Must be comfortable operating in a…