The Patient Financial Clearance Representative is responsible for overseeing the entire scope of financial clearance activities for assigned patients before the scheduled appointment date. 

Key responsibilities include:

• Confirming completeness of patient registration data.
• Verifying insurance eligibility and confirming health plan benefits.
• Procuring PCP referrals and health plan authorizations.
• Calculating and collecting patient liability estimates.
• Restricting or redirecting out-of-network patients.
• Communicating patient financial responsibility with consistency, clarity, and transparency.

The representative ensures that patients understand the cost of services, their insurance coverage and limitations, and their individual responsibility. Successful performance directly impacts health system goals, streamlining clinical operation workflows, improving revenue cycle operations, and enhancing financial performance.

Requirements:

• Licensure, Certification, or Registration for Hire: N/A

• Licensure, Certification, or Registration for Continued Employment: N/A

• Experience Required:

  • Minimum three (3) years of previous experience in a healthcare setting.
  • Experience in commercial, managed care, and governmental health insurance plans.
  • One (1) year experience in insurance plan authorization and referral requirements.
  • Medical billing experience.
  • Previous experience using a personal computer and various software applications, including Microsoft.
  • Strong customer service skills.

• Experience Preferred:

  • Previous experience using GE-IDX Patient Registration or other medical billing/registration systems.
  • Previous experience in ICD and CPT coding.
  • Previous experience using medical terminology.

• Education/Training Required:

  • High School Diploma or equivalent.

• Education/Training Preferred:

  • Post-high school education in healthcare or medical billing coursework.

Independent Actions Required:

• Collecting and updating patient demographic and insurance plan information.
• Verifying insurance plan eligibility and benefits.
• Calculating out-of-pocket liability and collecting required deposits, co-pays, deductibles, and outstanding balances from patients prior to service.
• Referring patients to financial counselors when assistance is needed.
• Coordinating with primary care physicians and health plans for referrals and authorizations.
• Maintaining thorough knowledge of commercial, managed care, and governmental health care plans.
• Maintaining thorough knowledge of insurance plan authorization and referral requirements.

Supervisory Responsibilities: N/A

Additional Position Requirements: May require work hours to periodically extend to 8:00 p.m. as necessary to resolve backlog or to contact patients for registration data.

Age Specific Groups Served: All

Physical Requirements:

• Physical: Lifting 20-50 lbs.
• Activities: Prolonged sitting, reaching (overhead, extensive, repetitive), repetitive motion, other: Prolong PC/keyboard usage.
• Mental/Sensory: Strong recall, reasoning, problem-solving, hearing, speak clearly, write legibly, reading, logical thinking, other: Concentrate/Focus.
• Emotional: Fast-paced environment, steady pace, able to handle multiple priorities, frequent and intense customer interactions, noisy environment, able to adapt to frequent change.

Equal Employment Opportunity (EEO) Statement: EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.

About Us: 

Inventing better care, day by day by discovery. Sound outrageous? It absolutely is. Sound impossible? That’s never stopped us before. Sound like hard work, intense research, collaboration with experts around the world, sheer brainpower meets unrelenting willpower? That’s. Exactly. Right.

We’ll do whatever it takes to offer the best in care and empower the best in the quality of life. And it’s an approach that works — whether it’s a patient undergoing a new, life-saving procedure or a clinical researcher finding promise in a new cancer treatment, exciting new medicine is happening at VCU Health.

We have it all:

• One college and four health sciences schools.
• An academic medical center.
• A Level I trauma center.
• One of only two NCI-designated cancer centers in Virginia.
• The region’s only full-service children’s hospital.
• More than 800 physicians in 200 specialties.
• With a community health center, dedicated research teams, facilities, and valued partners in every field.

Our medical teams are top-notch. From our very first years to our most recent advancements, we are driven to learn more, dig deeper, teach passionately, and never rest to be a true leader in discovering what’s possible in health and recovery. We are a comprehensive system of care and a pioneer of health. Read VCU Health Year In Review for more about our accomplishments.