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Financial Clearance Representative

MedStar Health
medical insurance
United States, D.C., Washington
Mar 25, 2025
Department: Admitting & Discharge Status: Full-time, 40-hours per week Schedule/Availability: 7:00am-6:30pm with rotating Saturday's Independently completes pre-registration and financial clearance activities for Washington Hospital Center patients. The Financial Clearance Representative is responsible for maintaining exemplary levels of customer service in all interaction in accordance to the Washington Hospital Center Mission and Vision. The following major functions describe the essential duties of positions in this job classification. Individual positions may not perform all of these tasks and/or may perform additional, related tasks not listed here. Assignments will be based upon enterprise needs and at the discretion of the Central Financial Clearance Managers and Director. Education High School Diploma or GED required May require up to 1 year of technical or other specialized training, such as training in data entry, medical terminology, and ICD-9/medical insurance coding/billing. Experience 1 to 3 years experience required Licenses and Certifications Medicare Regulation Certification within 1 Year required Knowledge, Skills, and Abilities Requires the ability to read and write; and knowledge of grammar, and arithmetic including fractions and decimals. May require the use of standard office/medical equipment (i.e., typewriter, personal computer, data terminal, on-line printer, calculator, telephone, facsimile, copier, sterilizing equipment, blood pressure cuff, or tables); the preparation, comparison or checking of reports, records and related data; and basic use of formulas, charts, tables, drawings and knowledge of their application. Completes Pre-registration activities and documents results in the registration system for scheduled patients, including contacting patients by phone or in person to obtain and verify demographic and insurance information, communicate outstanding liability, and relay necessary pre-arrival instructions. Uses customer service skills while communicating with the patient, insurance company, employer or third party payor to secure all demographic and financial data necessary for accurate and complete demographic and financial information. Contacts insurance carriers or reviews information from insurance verification systems to determine insurance coverage and eligibility. Resolves problems and coordinates payor payment responsibility between multiple carriers or source of coverage (i.e., coordinates benefits between primary, secondary, and tertiary payors). Updates patient accounts with appropriate insurance codes, authorization of treatment number, calculates number of inpatient days allowed, contacts referring or primary physicians if necessary and obtains provider numbers, etc. according to departmental policies and procedures. Reviews and updates demographic/insurance information and accounts status to ensure accounts meet payer requirements/timeframes for billing and payment. Ensures data quality standards are met through quality monitoring and report reviews. Obtains pre-certification/authorization when required for scheduled services prior to admission or outpatient procedure or upon admission for nonscheduled services. Notifies payors of admission or arrival according to facility contractual obligations. Makes final determination whether patients meet hospital financial/insurance eligibility criteria. Coordinates activites with physicians, insurance carriers, managed care payors, and other third party payers, patients, etc. regarding each admission/registration. Notifies appropriate physician/department/patient when eligibility or authorization criteria are not met and offers alternative options. Provides demographic/insurance or other related information to WHC departments (e.g., Social Work, Utilization Review, Physicians, Providers, etc.) as needed and according to department procedure. Determines, communicates, collects and documents patient liabilities prior to or at the time of service. Establishes contract agreements with patients, where applicable, per departments/hospital policy for outstanding balances. Educates patients and family members on insurance coverage and requirements, available resources, and hospital billing processes to ensure that patient's financial commitment to the institution is met. Accurately obtains ICD-9/HCPCS and CPT-4 codes from responsible parties as needed for billing purposes and/or estimating charges for self pay patients. Knows and adhere to government regulations relative to Medicare Secondary Payor (MSP) screening, Advance Beneficiary Notice (ABN), and Ambulatory Payment Classification (APCs). Researched denied accounts and recommends whether to appeal or accept the denial. Ensures that appropriate denial/appeal codes are entered into the billing system, within the required timeframes. Reviews/explains bill(s) to patients and/or third party payors. Requests corrections for any billing errors. Coordinates and addresses financial clearance issues for patients presenting at Sites of Service. Refers self-pay and other accounts to financial counseling as appropriate. Expands knowledge of current payors by staying abreast of changing guidelines and requirements. Performs other duties as assigned.