Summary

GENERAL STATEMENT OF DUTIES:

The Financial Support Representative is part of a multidisciplinary team charged with the responsibility

of providing accurate and professional financial clearance to patients scheduled for services at Johnston

Health (i.e. Inpatient Surgery, Same Day Surgery, Outpatient Diagnostic and Imaging procedures and services).  The Financial Support Representatives mitigate the financial risk to Johnston by performing an accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability. The Financial Support Representatives is responsible for performing all appropriate insurance verification, i.e.  verifying all insurance benefits and coverage, prior approvals, whether or not an authorization is required and that it is obtained at least the day prior to the patient’s arrival for surgery, any testing, Observation care, or In-patient Hospitalization.  The representative must check with all the payors to verify that an authorization has been started and is completed prior to service. If not, the representative must contact the provider’s office to obtain the status of the authorization. If the authorization is not obtained timely, the representative escalates this to management (Patient Access Manager, PFS Director, Chief Financial Officer and Chief Medical Officer) and informs the provider that the surgery may have to be rescheduled.

   The representative must maintain adequate communication with other department including Registration,  

   Billing, Scheduling, Care Management, and Operating Room, Provide offices, payors and others as indicated.

Coordination and communication with the care team is the key for successful financial analysis and clearance.   

Many of these accounts have large balances and the hospital will suffer tremendous loss if these responsibilities are not carried out timely and accurately.  The representative must ensure EPIC is updated with this information, that all work queues are properly worked and that each account is documented adequately such that others will know the status of the account immediately.

MINIMUM QUALIFICATIONS:

Graduate of a two year college program in Business Administration, Accounting, or other related program preferred. Two (2) - Three (3) years of healthcare experience in accounts receivable management functions and reimbursement for all payors and specifically Medicare and Medicaid.  Experience in authorizations is highly preferred. Experience should include insurance verification and authorizations for hospitals and customer service experience. Candidate must also possess a strong knowledge of medical terminology. Knowledge of EPIC, preferably HB registration software or hospital billing software.  Bilingual is a plus.

Must possess effective communication skills, assertiveness, effective interaction with peers and upper management, strong problem-solving skills, manages highly detailed issues, and effectively analyzes and interprets reports.