Financial Clearance Representative - Swedish American
Rockford, IL 61101
About the Job
At UW Health in northern Illinois, you will have:
• Competitive pay and comprehensive benefits package including: PTO, Medical, Dental, Vision, retirement, short and long-term disability, paternity leave, adoption assistance, tuition assistance
• Annual wellness reimbursement
• Opportunity for on-site day care through UW Health Kids
• Tuition reimbursement for career advancement--ask about our fully funded programs!
• Abundant career growth opportunities to nurture professional development
• Strong shared governance structure
• Commitment to employee voice
POSITION SUMMARY:
Under the direction of the Financial Clearance Supervisor, the Financial Clearance Representative enters and verifies demographic and insurance information, completes coordination of benefit changes, are responsible for assisting patients and families via phone and works closely with clinic, business office, and insurance company representatives as well as being the intake call center for the Financial Clearance Prior Authorization. The incumbent provides patient education around my chart troubleshooting and usage, referral requirements, and verbal authorization requirements.
The Financial Clearance Representative must consistently demonstrate the use of critical thinking skills, skilled communication and troubleshooting techniques as well as have excellent customer service skills. This position will have the ability to anticipate and respond to a wide variety of issues/concerns, and the ability to execute tasks efficiently and effectively. The position requires the ability to independently plan, schedule and organize numerous tasks as this position directly impacts patient care, hospital, and physician reimbursement. A substantial portion of the normal duties of the incumbent requires proper judgment, sensitivity, and strict adherence to UW Health policy on confidentiality.
This position represents UW Health and the Revenue Cycle team by adhering and upholding the UW Health Mission, Vision, and Values, and UW Health Service Performance Standards in providing the highest quality service. They will support their co-workers, engage in positive interactions, and provide helpful assistance in anticipating and responding to the needs of our customers.
EDUCATION/TRAINING:
Minimum:
High School Diploma of equivalent
Preferred:
Associate degree in business, Finance. Health Information Management or related field
LICENSURE/CERTIFICATION:
Minimum:
N/A
Preferred:
N/A
EXPERIENCE:
Minimum:
One (1) year of experience in a customer service-related field
Preferred:
One (1) year of experience in healthcare, call center, business, financial or insurance related field
REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES:
- Ability to work independently in a demanding environment.
- Must independently recognize and evaluate situations for the level of urgency.
- Experience in providing a high level of customer service.
- Strong emotional intelligence and empathy.
- Excellent written and oral communication skills.
- Strong computer and typing skills.
- Maintains effective and cooperative working relationships with co-workers, leaders, clinical staff, and the public.
- Must be detail oriented and accurate.
- Ability to multi-task and prioritize tasks.
- Displays an aptitude and willingness to learn new responsibilities along with department changes.
- Willingly accepts feedback.
- Flexible and innovative.
- Ability to problem-solve and work independently and not let external distractions interfere.
- Displays a professional appearance.
- Dependable and reliable in achieving goals.
- Experience operating office machines such as personal computers, fax machines, photocopier, and document scanners.
- Familiarity with medical terminology and abbreviations.
MAJOR RESPONSIBILITES:
Core Responsibilities:
- Completes registration, faxes, In Basket Messages, MyChart updates, Coverage Workqueues, Charge Review and Claim Edit Registration Error Workqueues for PB and HB Claims.
- Manage and enter incoming referrals and complete referral routing when possible. Contact patients for outgoing referral appointment dates via Referral Tracking Pending Workqueue.
- Identifies and confirms valid coverage for an episode of care and/or specific service and location: contacts insurance companies and/or reviews electronic response summary and coverage discovery information to ensure the appropriate coverages are on the patients record, and accurate claims can be sent out.
- Understands patient deductibles, out of network referrals, out of pocket limitations, and lifetime/event caps on liability. Refers patients to appropriate Financial Counselor, Prior Authorization or Billing based on financial coverage, financial situation, employment status, liability and/or patient concern.
- Reviews the account and timing of last patient demographic query to identify missing standard and/or required information. If necessary, contacts the patient to complete the information.
- Is attentive to and answers a high volume of incoming call center calls, and determines whether an outbound call is necessary, either to the patient or to the insurance company. For a call back, assesses the call and responds appropriately, attempting to resolve all patient inquiries.
- Communicates in a manner to ensure a positive patient or customer experience.
- Educates patients as needed on My Chart, referral requirements, Power of Attorney for Healthcare and financial responsibility, as well as other areas that they are expert in when needed.
- Knows key contacts in the organization to route callers to appropriate areas for help when they are unable to assist the patient or caller.
- Ensures all work is completed in a way that meets compliance requirements, including but not limited to, the completion of the MSPQ and standard documentation.
- Puts a high focus on energy of ensuring surgical and high-end imaging cases are worked timely and accurately to avoid delays in the prior authorization functions.
- Understands and integrates with the Financial Clearance Prior Authorization work to support those workflows from a registration perspective and to help avoid last minute cancellations or denials.
Customer Service Standards:
- Supports co-workers and engages in positive interactions.
- Communicates professionally and timely with internal and external customers.
- Demonstrates a professional and positive experience in all interactions with patients as well as internal and external stakeholders.
- Provides helpful assistance in anticipating and responding to the needs of our customers.
- Collaborates with customers in planning and decision making to result in optimal solutions.
- Ability to stay calm under pressure and deal effectively with difficult situations.
Our Commitment to Diversity, Equity, and Inclusion
UW Health is committed to being a diverse, inclusive and anti-racist workplace and is an Equal Employment Opportunity, Affirmative Action employer. Our integrity shines through in patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. Applications from Black, Indigenous and People of Color (BIPOC) individuals, LGBTQ+ and non-binary identities, women, persons with disabilities, military service members and veterans are strongly encouraged. EOE, including disability/veterans.PI251057329