About Xtend Healthcare
Xtend Healthcare is a revenue cycle management company focused exclusively on the healthcare industry. The company's services range from full revenue cycle outsourcing, A/R legacy cleanup and extended business office to coding and consulting engagements. As part of Navient (Nasdaq: NAVI), Xtend taps the strength and scale of a large-scale business processing solutions company. Learn more at www.xtendhealthcare.net
THIS POSITION IS REMOTE (WORK FROM HOME).
Xtend Healthcare is looking for Patient Business Service Representative - (Financial Clearance Specialist). This position ensures that all information necessary for proper financial reimbursement for patient care is collected and verified prior to the patient’s date of service. Collaborates with insurance companies when necessary to proactively validate benefits, eligibility, and referral requirements. Communicates with patients to assure they understand their payment obligations and steps necessary to meet these obligations, while maintaining a positive patient experience.
1. Financial Clearance
- Accesses work queues and reports and reviews patient accounts to determine financial clearance status of specific patient services and acts on those services not financially cleared.
- Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validates that coverages are assigned to appropriate visit.
- Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices. Enters and links referrals in system.
- Processes referrals when necessary, assuring proper tracking and redirection when appropriate. Understands each clinical department’s referral certification protocols and ensure referrals are certified at the appropriate level.
- Using system activities and functions, identifies non-covered services, and prepares proper Advance Notice Beneficiary (ABN) or waiver for registration team. Documents account for registrar action.
- Assists with precertification process when required.
- Verifies covered benefits, including remaining hospital days, carve out coverages and benefit limits of visit and/or timeframe.
2. Customer Service
- Communicates with patients and discusses their financial clearance status when necessary.
- Explains the status of any services not financially cleared and advises patients of the proper resolution steps, including self-payment.
- Directs patients to Financial Counselors when appropriate
- Works with the Financial Counselors, clinical departments, outside providers, third party insurers and any other individual or entity to assist in resolving patient financial clearance questions or problems in the most effective and positive manner possible.
3. Quality Management
- Meet and maintain Quality scores >= 91%.
- Maintain proper work queue management and process, acting where needed.
- Ensure all accounts are worked within client’s project standards
- Follow regulations outlined by state, federal, and third-party coverage procedures.
- Participate in and successfully completes Mandatory Education.
- Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
- High school diploma
- A minimum of 6 months of customer service required preferably in a hospital, physician or office support environment (additional equivalent education above the required minimum may substitute for the required level of experience)
- Experience with Hospital and/or Physician business office operations requiring knowledge of health insurance coverage and/or reimbursement preferred.
- Experience with Insurance payers (Medicare, Medicaid, Commercial, Workers Compensation) preferred
- Experience providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data
- Exceptional customer service skills.
- Excellent verbal and written communication skills.
- Dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality.
- Proficient use of hospital registration and/or billing systems, and Microsoft Word and Excel software applications.
- Ability to follow regulations outlined by state, federal, and third-party coverage procedures.
- Ability to model the basic values of the mission, vision and values of Xtend Healthcare and the client.
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