Financial Clearance Representative

Finance & Revenue Cycle Worcester, Massachusetts


Description

Position at UMass Memorial Health Care

Everyone Is a Caregiver.

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.

Requisition #: 213409

Title: Financial Clearance Representative

Department: Patient Access Services

Grade: ADM5

Posting Date: April 6, 2021

Status: Non-Exempt

Shift: Days

Union:  SHARE

Hours: 40

Shift Length: 8

Location: UMass Memorial Medical Center

Position Summary:

Performs a variety of complex duties utilizing insurance and payor knowledge to ensure that all inpatient admissions, surgical procedures, provider visits, tests and ancillary services are financially cleared prior to release of a claim to the insurance company. 

Major Responsibilities:

  • Works the referrals work queue and verifies that all authorizations and pre-certifications are in place prior to services being rendered and align with provided CPT and ICD-10 codes. Investigates all elective same day surgeries and inpatient admissions for referral and/or authorization requirements.
  • Verifies insurance eligibility utilizing available technologies, payor websites, or by phone contact with third party payors.
  • Verifies patient insurance coverages using real time eligibility or batch processing as appropriate.
  • Verifies that the correct insurance company name, address, plan, policy number and filing order are entered in the Epic system.
  • Work patient and payor work queues so that patient accounts are complete prior to services being rendered.

Position Qualifications:

License/Certification/Education:

Required:

  • High school diploma.

Experience/Skills:

Required:

  • Minimum of 1 year of business office or related insurance experience.
  • Knowledge of third party requirements as they relate to insurance verification/authorization.
  • Demonstrated ability to work with computerized systems.
  • Excellent communication skills to interact with insurance companies, physicians’ offices, and patients.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Standards of Respect: