Financial Clearance Representative Lead at UnitedHealth Group in Plymouth, MN

Job description

Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Financial Clearance Representative Lead is responsible for completing the financial clearance process and creating the first impression of Allina’s services to patients, their families, and other external customers. Must be able to articulate information in a manner that patients, guarantors, and family members understand and will know what to expect regarding their financial responsibilities. Works with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial services. Functions as a subject matter expert for the department. Coaches and mentors are experienced staff on all aspects of financial clearance. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Perform financial clearance processes by interviewing patients and collecting and recording all necessary information for pre-registration of patients Educate patients of pertinent policies as necessary i.e., Patient Rights, HIPAA information, consents for treatment, visiting hours, etc. Verify insurance eligibility and completes automated insurance eligibility verification, when applicable and appropriately documents information in Epic Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure Confirm what benefits of a patient’s upcoming visit/stay are covered by the patient’s insurance(s) including exact coverage, effective date of the policy, coverage limitations / requirements, and patient liabilities for the type of service(s) provided Provide proactive price estimates and work with patients so they understand their financial responsibilities Inform families with inadequate insurance coverage of financial assistance through government and financial assistance programs and refers the patient to financial counseling Review and analyze patient visit information to determine whether authorization is needed and understands payor specific criteria to appropriately secure authorization and clear the account prior to service where possible Ensure that initial and all subsequent authorizations are obtained in a timely manner Provide mentoring and daily workflow coaching to less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role Performs Enhanced Financial Clearance activities: May complete admission reviews for hospital admissions to support the authorization process May complete notification of hospital admission and discharge for hospital admissions Expanded insurance benefit review for more complex and/or high dollar procedures Perform financial counseling with patients; includes evaluating assistance programs the patient may qualify for, completing applications, determining the need for delay/cancel of services and escalating as needed May be assigned to work special projects and/or non-standard workflows Organize and coordinate Financial Clearance team activities: Provide day-to-day work assignments, oversight and leadership to staff Work with the department Supervisor to set standards, develop and execute improvement plans Alert Supervisor of any backlogs and provides suggestions for resolution Communicate issues that need management attention and/or identifies areas where staf