Patient Fin Clearance Rep

VCU Health System - Richmond, VA3.6

VCU Health System's CHoR Administration is seeking a Patient Financial Clearance Rep. This individual will provide financial clearance activities for patients before the scheduled appointment date. This may include confirming completeness of patient registration data, verifying insurance eligibility, confirming health plan benefits, procuring PCP referrals and health plan authorizations, calculating and collecting patient liability estimate, and clearly communicating patient financial responsibility to ensure the patients understand the cost of services they receive, their insurance coverage and limitations, and their individual responsibility.

Collects and updates patient demographic and insurance plan information

Verifies insurance plan eligibility and benefits using multiple system and web-based tools, as well as calling payer and patient as necessary

Calculates out-of-pocket liability and collects required deposits, co-pays, deductibles and outstanding balances from patient prior to service.

Refers patients to financial counselors when assistance needed to identify alternate payer source or establish payment plan

Contacts in-house and community primary care physicians to secure PCP referral for consult and treatment as required by health plan

Contacts health plan to secure prior authorization for procedures/testing as required by health plan

Coordinates peer-to-peer review between VCUHS physicians and health plan medical directors to secure prior authorization for services

Prepares all forms required to obtain payment from third party payer for services

Determines when appropriate to apply additions/revisions to patient account and current visit

Maintains thorough knowledge of commercial, managed care and governmental health care plans

Maintains through knowledge of insurance plan authorization and referral requirements

May require work hours to periodically extend to 8:00 pm as necessary to resolve backlog or to contact patients for registration data


Minimum two (2) years of previous experience in a health care setting to include:

Experience in commercial, managed care and governmental health insurance plans and

One (1) year experience in insurance plan authorization and referral requirements; or Medical billing

Previous experience using a personal computer and various software applications, including Microsoft, e-mail, etc.

Strong customer service skills and patients/customers centered focus in a positive manner in all situations


Previous experience using GE-IDX Patient Registration or other medical billing/registration system
Previous experience in ICD and CPT coding
Previous experience using medical terminology

Qualified applicants will receive consideration for employment without regard to their protected veteran or disability status.

HR Use Only: PTO