Overview This position is responsible for completing the financial clearance process within Patient Access. The financial clearance rep (FCR) verifies insurance online and over the phone and obtains referrals and authorizations for patients as outlined by each individual’s insurance for Fairview Rehabilitation Services (FRS). The FCR is responsible for tracking/correcting all pertinent insurance information into Epic and provide clinics and patients with the most accurate data as it pertains to receiving services with FRS.This is a higher level position that requires understanding of, and working with multiple insurance payors, to secure benefits and increase the likelihood of reimbursement for Fairview at the highest benefit level. Remote position. FTE 1.0, authorized to work 80 hours per pay period. Schedule: Monday - Friday, 8:30am- 5:00pm. Full benefits such as medical, HSA, dental insurance, vision insurance, 403b, PTO, health & wellbeing resources, Health & Wellness funding, and more! M Health Fairview Rehabilitation offers a broad range of services that serve patients across 10 acute-care hospitals, 3 post-acute settings and 70 outpatient adult and pediatric therapy clinics. Consisting of Physical, Occupational and Speech Therapy as well as Audiology and Cardiac & Pulmonary Rehab, our therapists collaborate with colleagues in all medical settings and offer dozens of specialty programs. As an academic health system with residency and fellowship programs and a rehab-focused clinical quality team, we have a collaborative culture that is centered on learning with an emphasis on evidence based, patient-centered care. Rehab’s continuing education program offers continuing education courses per year at no cost to employees. Responsibilities Job Description The FCR must be able to effectively articulate payor information in a manner such that therapists, patients and families gain a clear understanding of financial responsibilities.The FCR will be responsible for completing the insurance and benefits verification to determine the patient’s benefit level for Outpatient therapy services including Physical, Occupational, Speech, Cardiac, Pulmonary, and Hearing Aids/Audiology. They will obtain benefit levels, screen payor medical policies to determine if the scheduled procedure meets medical necessity guidelines, submit and manage referral and authorization requests/requirements when necessary, and/or ensure that pre-certification notification requirements are met per payor guidelines. They will provide support and process prior authorization appeals and denials, when necessary, in conjunction with revenue cycle and clinical staff. The FCR makes the decision when and how to work with providers, clinical staff, insurance payors and other external sources to assist in obtaining healthcare benefits. Registration and Coverage Performs financial clearance process by interviewing insurance payers and collecting and recording all necessary benefit information for patients. Ensures that proper insurance payor plan code is entered in Epic and attached to relevant visits. Verifies relevant group/ID numbers, guarantors and other coverage details. Financial Screening Verifies insurance eligibility. Completes automated insurance eligibility verification, when applicable and appropriately documents information in Fairview’s patient accounting system. Determines the patient’s insurance type and documents coverage and/or coverage issues. Informs families with inadequate insurance coverage regarding possible out of pocket costs or network issues that may result in little or no coverage. Initiates treatment authorization requests and pursues referrals per payor guidelines. Reviews medical chart/history and physician order(s) to determine likely ICD and CPT codes. Reviews payor medical policies to determine if procedures meet medical necessity guidelines. Follow up with insurance payors on prior authorization determinations and denials. Qualifications Required 4 years experience working in revenue cycle, insurance verification/eligibility, financial securing or related areas. Experience with practice management software, hospital billing software or electronic health record software. Preferred Previous Epic experience 1 year in healthcare or insurance related field Vocational/Technical Training or Associate’s Degree EEO Statement EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status