NI-Financial Clearance Representative

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

5/23/2024

Entity:

Illinois

Job Code:

NI-4466AC

Job Title:

NI-Financial Clearance Representative

FLSA Exemption Status:

Non-Exempt

JOB 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.

ESSENTIAL DUTIES

•

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.

•

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.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

High School Diploma

or equivalent.

Required

Associate degree in business, Finance. Health Information Management or related field.

One (1) year of experience in a customer service-related field.

Required

One (1) year of experience in healthcare, call center, business, financial or insurance related field.

Preferred

Experience in providing a high level of customer service.

Required

Experience operating office machines such as personal computers, fax machines, photocopier, and document scanners.

Required

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

Ability to work independently in a demanding environment.

•

Must independently recognize and evaluate situations for the level of urgency.

•

Strong emotional intelligence and empathy.

•

Excellent written and oral communication skills.

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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.

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Ability to multi-task and prioritize tasks.

•

Displays an aptitude and willingness to learn new responsibilities along with department changes.

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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.

•

Familiarity with medical terminology and abbreviations.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Standing

X

Walking

X

Climbing

X

Bending

X

Crouching

X

Pushing / Pulling

X

Carry

X

Fine Hand / Eye Coordination

X

Color Discrimination

X

Hearing Ability

X

Lifting / Lowering 1 -15 lbs.

X

15 - 30 lbs.

X

30 - 50 lbs.

X

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Concentration on Detail

X

Attention Span of 1 + Hours on a Task

X

Ability to Remember Multiple Tasks

X

Oral Communication

X

Written Communication

X

Exposure to Blood and Body Fluids

X

Exposure to Toxins, Cytotoxins, Poisons

X

Exposure to Extreme Heat, Cold, Temp Fluctuations

X

Exposure to Hazardous Chemicals

X

Exposure to Radiation

X

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.