The Patient Financial Clearance Representative Senior demonstrates strong customer service orientation while handling all business functions in an assigned area to secure the appropriate patient information; ensure that registration data is correct and accurate; validate insurance eligibility, enter information into appropriate systems, collects co-pay (if applicable), and assist with financial counseling and financial clearance, as necessary. This role performs all aspects of the Patient Financial Clearance rep position as needed. In addition, the Patient Financial Clearance Representative Sr. provides real time training when there are new representatives, providing troubleshooting guidance and mentorship.

Essential Job functions: 

• Communicates effectively with patients, clinical staff, and providers when the postponement of services is necessary due to lack of eligibility or benefits. 

• Prioritizes and coordinates patient accounts that require completion of patient demographic, third party payer and visit data prior to the appointment date. Independently resolves missing or incorrect data elements, specifically for defined critical data set.  

• Applies additions and revisions to patient’s EPIC account utilizing established registration policies and procedures. 

• Determines appropriateness of applying plan additions or revisions to past and future scheduled visits and takes appropriate action. 

• Contacts patient or guarantor by phone, portal, email, or mail and communicates in a professional and courteous manner as necessary to complete or update demographic, third party payer or visit data. 

• Uses knowledge and accuracy in updating registration data according to established policies and procedures by consistently achieving an accuracy rate of 97% or greater on the EPIC Registration Audit Program 

• Confirms eligibility and benefits of current health plan for assigned patients prior to scheduled outpatient visit date. 

• Utilizes combination of on-line eligibility tool, health plan web-based sites, and telephone confirmation with health plan representative to determine current eligibility and benefits. 

• If eligibility or benefit confirmation is unsuccessful after exhausting all available methodologies, contacts patient or guarantor by phone, email, or portal to communicate eligibility and benefit limitations and/or obtain new health plan data. 

• May require ability to cancel or reschedule appointments when additional time is needed to confirm health plan eligibility and/or benefits to guarantee payment. 

• Provides coaching and supports the development and acquisition of job-specific skills 

• Ensures responsibility and visible commitment to diversity, equity, and inclusion programs/initiatives through collaboration and implementation of initiatives across the health system.   

• Perform other duties as assigned and/or participates in special projects in order to support the mission of VCUHS and the Department. 

Patient Population: 

Not applicable to this position. 

Employment Qualifications: 
 
Required Education:     
High School Diploma or equivalent 

Preferred Education:  N/A 

Licensure/Certification Required: N/A 

Licensure/Certification Preferred:  N/A 

Minimum Qualifications: 
 
Required Qualifications:   

Minimum three (3) years of previous experience in a health care setting to include:  

Experience in commercial, managed care and governmental health insurance plans and  

One (1) year experience in insurance plan authorization and referral requirements; or medical billing 

Other Knowledge, Skills and Abilities Required:   

Previous experience using a personal computer and various software applications, including Microsoft, e-mail, etc.  

Strong customer service skills and patients/customers centered focus in a positive manner in all situations. 

Cultural Responsiveness:     
Demonstrates a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias. 

Other Knowledge, Skills and Abilities Preferred:  

Use of Patient Registration or other medical billing/registration systems, ICD and CPT coding, medical terminology 

Working Conditions: 

General office environment. 

Prolonged periods of working alone. 

Physical Requirements: 
 
Physical Demands: Lifting/ Carrying (0-50 lbs) 

Work Position:  Sitting, Walking, Standing 
 
 

Additional Physical Requirements/ Hazards: 
 
Physical Requirements:   

Repetitive hand arm/hand movements 

Mental/Sensory - Emotional: 
 
Mental/Sensory: Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical Thinking 

Emotional: Steady-paced environment, Frequent and intense customer interactions, Able to adapt to frequent change 

Workday Day (United States of America)

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