Business Financial Clearance Coordinator
Job ID: R0038239 | Health Services Administrative | Full Time | Charlottesville, VA
This role is responsible for managing the financial services functions for Stem Cell Transplant patients. This includes, but is not limited to, insurance eligibility and verification of benefits, obtaining all necessary pre-authorizations and authorization for transplant event and admission for Stem Cell transplant, and ongoing discussion and collection with patient of any financial responsibility. Additionally, the Coordinator will provide necessary support functions within the PAU and act as the liaison with patient financial services group.
  • Performs financial screening/interviews of all patients via phone prior to presenting for clinical transplant consult.
  • Researches and verifies insurance and benefits for hospital and professional coverage.
  • Works with pharmacy to ensure pharmacy coverage and immunosuppressive medications are authorized by appropriate teams.
  • Collects information from patient and determines benefits, including what type of coverage may be obtained for the patient (i.e., Medicare, Medicaid, and spend-down information). Assists the patient/guarantor in obtaining other resources if eligibility has been terminated.
  • Quotes co-payments, deductibles, and coinsurance according to policy and contracts to patients/guarantors. Collects any out-of-pocket monies identified during benefits check. Obtains approval from management for various payment options that ensure compliance and minimized collection expenses.
  • Supports the insurance referral process when coverage needs to be clarified, especially for out-of-network plans.
  • Collects and submits necessary clinical documentation and correspondence for all pre-transplant service, transplant event, admission, and post-transplant authorizations.
  • Participates in meetings with stem cell transplant department on as-needed basis to ensure coordination of clinical and financial information.
  • Reviews daily Epic reports and Epic work queues to determine if the visit is stem cell transplant-related and requires financial clearance follow-up.
  • Updates appropriate Epic flags, guarantor, registration, insurance(s), and authorization(s), as well as appropriate billing indicators.
  • Assists Patient Financial Services department with billing questions related to Stem Cell Transplant visits.
  • Adheres to contractual guidelines and accepted payers' and associated global billing periods with insurance companies when obtaining initial or continuing authorization for services.
  • Makes every effort to minimize the loss of reimbursement for lack of notification, lack of authorization, or denied days due to lack of continuing authorization. Analyzes denials where necessary to determine root cause.
  • In addition to the above job responsibilities, other duties may be assigned.

Position Compensation Range: $17.65 - $27.36 Hourly

  • Education: High school graduate or equivalent. Bachelor's degree preferred.
  • Experience: Two years of experience in financial counseling, insurance reimbursement, benefits, and prior authorizations. Stem cell transplant experience preferred.
  • Licensure: None.

Job requires sitting for prolonged periods and attention to detail. Must be able to hear, speak, read, and write legibly.

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Charlottesville, VA
Charlottesville, VA 22903

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