Patient Financial Clearance Representative

The Patient Financial Clearance Representative works under the direction of the Manager responsible for ensuring all financial record are accurate and in place prior to the patient's arrival. The Patient Financial Clearance Representative possesses the highest customer services skills as the first touch in the patient experience chain. The Patient Financial Clearance Representative sets the tone for what is the first and can be the lasting impression of the patient's perception of Mosaic Life Care. Works as a liaison between Ordering Offices and Mosaic Life Care for obtaining patient information and prior authorization detail for scheduled services. Pre-certifies insurance for scheduled procedures and/or tests to expedite reimbursement and avoid authorization penalties.

Responsibilities

• Makes outbound calls pre-service to for patients that have upcoming services scheduled with Mosaic Lifecare. Maintains a professional and courteous tone of voice and communication clearly with the patient.
• Reviews patients estimated out of pocket amount due for services for both Clinic and Medical Center services and requests payment over the phone prior to service. Also communicates any previous balance due from the patient on past balances.
• Communicates the Mosaic Lifecare Financial Assistance Policy and based on need determined by the PARO score and evaluates the patients need.
• Discusses any out of network and non-covered services with the patient to ensure the patient is prepared for any out of pocket expenses prior to service.
• Reviews and confirms patients insurance is eligible for the date of service. Research any patient that is not eligible to identify other coverage.
• If the patient is unable to pay their estimated out of pocket the Patient Financial Clearance representative will evaluate the patient’s ability to qualify for Mosaic’s loan financing program.
• Confirms with the patient the accuracy of all registration data fields and updates any necessary changes to the patient’s demographic information.
• Verifies the patients’ health insurance information with the patient to ensure accuracy of billing.
• De-escalates patient complaints related to current or past due balances. Researches the Patient Accounting system to assist the patient with any questions related to previous visits related to registration, charging, and billing.
• Complies with department standard for length of call, speed to answer, and aids in the prevention of abandoned calls.
• Other duties as assigned

• H.S. Diploma - Preferred
• Associate's Degree - Preferred

• 1 Year - Experience with pre-access services policies - Required

• Upon Hire

• Travel to off-site locations may be required. - Required

Qualifications

Essential Technical/Motor Skills

• Communicates clearly and concisely; good hand eye coordination

Interpersonal Skills

• Excellent oral and written communication skills.
• Maintains good rapport and professional relationship with caregivers.
• Demonstrates excellent customer service skills by maintaining friendly, courteous and helpful behaviors.

Essential Physical Requirements

• Ability to operate equipment on continuous/repetitious basis such as computer, telephone, fax and copier.
• Multi-skilled responsibilities require sitting, walking and standing.

Essential Mental Abilities

• Analyze and interpret data.
• Excellent short term and long term memory.
• Ability to perform multiple tasks and follow system policies and procedures.

Essential Sensory Requirements

• Visually assess paper and electronic data, hear telephone and converse

Exposure to Hazards

Other Skills and Abilities

• Demonstrated self-starter.
• Excellent oral, written, and interpersonal communication skills; excellent organizational skills.
• Ability to quickly assess and respond appropriately to emergency situations.
• Ability to comprehend medical terms.
• Analytical skills to resolve complex problems requiring the use of scientific, mathematical, or technical principles.
• Knowledge and experience with a variety of information systems and Internet usage; experience with spreadsheet and word processing software.
• Ability to work independently and manage individual workload to meet productivity standards along with a varied schedule, which includes weekend and evening coverage.