Job Summary:
This position is responsible for completing the financial clearance process within Mental Health and Addiction Patient Access for acute inpatient hospitalizations, routine outpatient evaluations, and routine mental health care authorizations. This is a higher-level position in the FSC that requires understanding of and working with multiple insurance payors to secure benefits and increase the likelihood of reimbursement for Fairview at the highest benefit level.
The Financial Clearance Rep (FCR) makes the decision when and how to work with psychiatry providers, insurance payors and other external sources to assist families in obtaining healthcare and financial services.
Job Expectations:
Registration:
Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration of patients. Ensures that proper insurance payor plan choice and billing address are assigned in the automated patient accounting system. Verify relevant group/ID numbers as well as ensuring the proper behavioral account is attached to each hospital account record (HAR) to ensure payment for services.
Financial Screening:
The FCR must be able to effectively articulate payor information in a manner such that patients, guarantors, and family members gain a clear understanding of their financial responsibilities.
The FCR will be responsible for completing the insurance and benefits verification to determine the patient’s benefit level. They will screen payor medical policies to determine if the scheduled procedure meets medical necessity guidelines, submit, and manage referrals and authorization requests/requirements when necessary, and/or ensure that pre-certification and admissions notification requirements, both inpatient and outpatient, are met per payor guidelines. They will provide support and process prior authorization appeals and denials, when necessary, in conjunction with revenue cycle and clinical staff.
Verifies insurance eligibility. Completes automated insurance eligibility verification, when applicable and appropriately documents information in Fairview’s patient accounting system.
Determines the patient’s insurance type and educates patients regarding coverage and/or coverage issues and ensures the proper behavioral payer account is uploaded to ensure reimbursement and reduce denials.
Informs families, providers, and behavioral Utilization Management teams with inadequate insurance coverage regarding financial assistance through government and Fairview financial assistance programs. Performs initial financial screening and refers accounts for financial counseling.
Initiates treatment authorization requests and pursues referrals per payor guidelines. Reviews medical chart/history and physician order(s) to determine likely ICD and CPT codes that are billable services for the appropriate level of care.
Reviews payor medical policies to determine if procedures meet medical necessity guidelines.
Works with behavioral Utilization Management teams, mental health providers, 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:
Educates patients and attempts to collect co-payments, co-insurance, and deductibles per Fairview’s POS collections policies and procedures.
Organization Expectations, as applicable:
Minimum Qualifications to Fulfill Job Responsibilities:
Required
Experience
Preferred
Education
Experience