Medical Office Collections Specialist

4 weeks ago


Saint Paul, Minnesota, United States Fairview Health Services Full time
Job Summary

As a Financial Clearance Representative for Fairview Health Services, you will play a critical role in ensuring that patients receive the necessary financial clearance for their medical procedures. This position requires strong communication and organizational skills, as well as the ability to work effectively with multiple insurance payors to secure benefits and increase the likelihood of reimbursement for Fairview at the highest benefit level.

Responsibilities

Perform financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration of patients.
Ensure that proper insurance payor plan choice and billing address are assigned in the automated patient accounting system.
Verify relevant group/ID numbers.

Financial Screening

Verify insurance eligibility.
Complete automated insurance eligibility verification, when applicable and appropriately document information in Fairview's patient accounting system.
Determine the patient's insurance type and educate patients regarding coverage and/or coverage issues.
Inform families with inadequate insurance coverage regarding financial assistance through government and Fairview financial assistance programs.
Perform initial financial screening and refer accounts for financial counseling.
Initiate treatment authorization requests and pursue referrals per payor guidelines.
Review medical chart/history and physician order(s) to determine likely ICD and CPT codes.
Review payor medical policies to determine if procedures meet medical necessity guidelines.
Work with clinics and ancillary service departments if medical necessity fails.
Follow up with insurance payors on prior authorization denials. Process authorization denial appeals, when necessary.

Point of Service Collection

Educate patients and attempt to collect co-payments, co-insurance, and deductibles per Fairview's POS collections policies and procedures.

Qualifications

Associate degree in business, healthcare, or related area. 2 years of revenue cycle experience may substitute for an associate degree.
1 year of experience working in revenue cycle, insurance verification, financial securing, or related areas using an EHR or enterprise software system in a healthcare organization. This experience must be in addition to two years of experience in lieu of associate degree requirement above.
Knowledge of insurance terminology, plan types, structures, and approval types.
Knowledge of computer systems, including Microsoft Office 365.

Preferred Qualifications

Experience with referrals and/or prior authorization.
Epic experience.
Knowledge of medical terminology and clinical documentation review.

EEO Statement

Fairview Health Services is an EEO/AA Employer/Vet/Disabled. All qualified applicants will receive consideration without regard to any lawfully protected status.

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