Patient Financial Clearance Rep - Adult Outpatient Pavilion - Infusion Services

Patient Financial Clearance Rep - Adult Outpatient Pavilion - Infusion Services

Overview: The Patient Financial 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/ collecting patient liability estimate, restricting/redirecting out‑of‑network patients, and communicating patient financial responsibility. The Rep ensures patient financial responsibility is communicated with consistency, clarity, and transparency to help patients understand the cost of services, their insurance coverage and limitations, and their individual responsibility.

• Collect and update patient demographic and insurance plan information.
• Verify insurance plan eligibility and benefits using multiple systems, web‑based tools, and phone calls to payers and patients.
• 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 alternative payer sources or establish payment plans.
• Contact in‑house and community primary‑care physicians to secure PCP referrals for consult and treatment as required by the health plan.
• Contact health plans to secure prior authorization for procedures or testing as required.
• 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.
• Determine when appropriate to apply additions or revisions to the patient account and current visit.
• Maintain thorough knowledge of commercial, managed‑care, and governmental health‑care plans and insurance‑plan authorization and referral requirements.

• Minimum three (3) years of previous experience in a health‑care setting, including experience with commercial, managed‑care, and governmental health‑insurance plans.
• At least one (1) year of experience in insurance‑plan authorization and referral requirements, or medical billing.
• Proficiency with personal computer and various software applications (Microsoft Office, e‑mail).
• Strong customer‑service skills with a patient‑centered focus.
• Preferred:
  Experience using GE‑IDX patient registration or other medical billing/registration system.
• Preferred:
  Experience in ICD and CPT coding.
• Preferred:
  Experience using medical terminology.
• High school diploma or equivalent (required); post‑high‑school education in healthcare or medical‑billing coursework (preferred).

Use of assistance devices as appropriate. Lifting 20–50 lbs. Prolonged sitting, reaching overhead, repetitive motion. PC/keyboard usage. Strong recall, reasoning, problem‑solving, hearing, speaking clearly, writing legibly, reading, logical thinking, concentration, focus. Able to handle multiple priorities in a fast‑pace, noisy environment.

May require work hours to extend to 8:00 p.m. as necessary to resolve backlog or to contact patients.

VCU Health is an equal opportunity employer. EEO Employer/Disabled/Protected Veteran/41 CFR 60‑1.4.