Patient Financial Clearance Representative - Adult Outpatient Pavilion - Hybrid

Patient Financial Clearance Representative - Adult Outpatient Pavilion - Hybrid

$1,000 Sign On Bonus for offers accepted by November 30, 2025. Terms and Conditions apply.

The Patient Fin Clearance Rep is responsible for the entire scope of financial clearance activities for assigned patients before the scheduled appointment date. Financial clearance includes confirming completeness of patient registration data, verifying insurance eligibility, confirming health plan benefits, procuring PCP referrals and health plan authorizations, calculating and collecting patient liability estimates, restricting or redirecting out‑of‑network patients, and communicating patient financial responsibility.

The Patient Fin Clearance Rep ensures patient financial responsibility is communicated with consistency, clarity, and transparency so patients understand the cost of services, insurance coverage, limitations, and their individual responsibility. Successful performance of job duties directly impacts the health system’s goals of streamlining clinical workflow and improving revenue cycle operations and financial performance.

Licensure, Certification, or Registration Requirements for Hire: N/A

Licensure, Certification, or Registration Requirements for continued employment: N/A

Experience

REQUIRED:

Minimum three (3) years of previous experience in a health‑care setting, including experience with commercial, managed care, and governmental health insurance plans; one (1) year experience in insurance plan authorization and referral requirements; or medical billing. Previous experience using a personal computer and various software applications, including Microsoft, e‑mail, etc. Strong customer service skills and patient‑centered focus in a positive manner in all situations.

Experience PREFERRED: Previous experience using GE‑IDX Patient Registration or other medical billing/registration system; experience in ICD and CPT coding; experience using medical terminology.

Education/training

REQUIRED:

High School Diploma or equivalent.

Education/training PREFERRED: Post‑high school education in healthcare or medical billing coursework.

Independent action(s) required:

• Collect and update patient demographic and insurance plan information.
• Verify insurance plan eligibility and benefits using multiple systems and web‑based tools, as well as calling payers and patients as necessary.
• Calculate out‑of‑pocket liability and collect required deposits, co‑pays, deductibles, and outstanding balances from patients prior to service.
• Refer patients to financial counselors when assistance is needed to identify alternate payer sources or establish payment plans.
• Contact in‑house and community primary‑care physicians to secure PCP referral for consult and treatment as required by health plan.
• Contact health plan to secure prior authorization for procedures/testing as required by health plan.
• Coordinate peer‑to‑peer review between VCUHS physicians and health plan medical directors to secure prior authorization for services.
• Prepare all forms required to obtain payment from third‑party payers for services.
• Determine when appropriate to apply additions or revisions to patient accounts and current visits.
• Maintain thorough knowledge of commercial, managed care, and governmental health‑care plans.
• Maintain thorough knowledge of insurance plan authorization and referral requirements.

Supervisory responsibilities (if applicable): N/A

Additional position requirements: May require working hours to periodically extend to 8:00 p.m. as necessary to resolve backlog or to contact patients for registration data.

Age Specific groups served: All.

Physical Requirements (includes use of assistance devices as appropriate):

• Physical:
  Lifting 20‑50 lbs.
  
  Activities:
  
  Prolonged sitting, reaching (overhead, extensive, repetitive), repetitive motion.
• Other:
  Prolonged PC/keyboard usage.

Mental/Sensory: Strong recall, reasoning, problem solving, hearing, speaking clearly, writing legibly, reading, logical thinking.

Other: Concentrate/focus, emotional:
Fast pace environment, steady pace, able to handle multiple priorities, frequent and intense customer interactions, noisy environment, able to adapt to frequent change.

Rotating

EEO Employer/Disabled/Protected Veteran/41 CFR 60‑1.4.