General Summary


Determines eligibility for third party payor benefits and obtains initial financial authorization when required. Notifies patient/family and clinical area if third party coverage will not reimburse any or all of the planned care. Identifies alternative payment options to the patient/family and refers appropriate cases to the Care Manager.


Consistently demonstrates support of the RIC Statement of Mission and Philosophy by striving for excellence, contributing to the team effort and showing respect and compassion for patients and their families, fellow employees and all others with whom there is contact at or in the interest of the Institute.


Demonstrates RIC Core Attributes: Communication, Accountability, Flexibility/Adaptability, Judgment/Problem Solving, Customer Service and RIC Values (Hope, Compassion, Discovery, Collaboration, & Commitment to Excellence) while fulfilling job duties.


Principal Responsibilities


1. Researches and verifies financial coverage for planned services, prior to patient''s scheduled appointment. Elements of financial clearance include the following:
a. If the patient has coverage under a third party payor:


- Confirms that the coverage is currently active.
- Determines whether planned services are a covered benefit under the patient''s benefit plan, including any financial or visit limitations and any requirements to use an in-network provider to qualify for the maximum level of reimbursement.
- Completes any authorization requirements for the patient''s specific plan, such as pre-certification, plan authorization, and/or obtaining a referral from the primary care physician.


b. If the patient does not have coverage under a third party payor, or the coverage is insufficient for the anticipated services:
- Communicates limitations, denials, penalties, or non-covered services to patient/family.
- Discusses financial options for services not reimbursable by a third party payor.
- If the patient elects to self-pay, requests guarantor to sign an acknowledgement of non-reimbursable services and agreement to self-pay.
- Refers case to outpatient Care Manager or Social Worker when the patient is unable to pay for services ordered and they are not covered under a third party payor.


c. Documents receipt of and forwards appropriate forms (such as a primary care physician referral or a signed agreement to self-pay) to Patient Financial Services.
d. Documents all financial clearance information in RIC''s Information System


2. Updates demographic, insurance, funding and medical information in RIC''s Information System, as needed.
3. Communicates information to the outpatient clinical team or RIC inpatient Care Managers, as needed.
4. Communicates all actual or potential denials to Financial Clearance Supervisor.
5. Carries out other duties and responsibilities as assigned.


Reporting Relationship


Financial Clearance Coordinator position reports to the Supervisor, Financial Clearance


Knowledge, Skills & Abilities Required


1. Level of knowledge as normally acquired through prior registration / preregistration experience or related experience.
2. Knowledge of health care delivery services and the field of rehabilitation medicine preferred.
3. Working knowledge of Windows operating environment and Microsoft Office software applications.
4. Strong customer service and interpersonal skills necessary to interact with all levels of Institute personnel, physicians, insurance representatives, and other internal and external customers.
5. Analytical skills necessary to ensure complete, accurate and timely financial clearance is obtained for all outpatients receiving rehabilitation services at RIC.
6. Minimum educational requirements include a high school degree or equivalent, an Associates degree is preferred.


Working Conditions


Normal office environment with little or no exposure to dust or extreme temperature.


The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
Job Grade- 06