Insurance Clearance Representative

The Insurance Clearance Representative plays a key role in the revenue cycle by ensuring patient accounts are verified and accurate information is entered for smooth billing and reimbursement. As a connector between front-end patient services and back-end financial operations, this position helps minimize payment delays, reduce denials, and improve operational efficiency through proactive communication and benefit verification. If you’re passionate about fostering a positive patient experience and supporting our commitment to excellence and operational efficiency, you would be a great addition to our team.

What You'll Do:

• Funding Source Accuracy & Claims Transmission:
  • Verify the accuracy of funding source entry during the registration process.
  • Ensure funding sources are correctly aligned to transmit claims to the appropriate payer or third-party administrator (TPA).
  • Collaborate with cross-functional teams to prevent claim delays caused by incorrect payer assignments.
  • Collaborate with front office when patient responsibilities are not paid or issues with credit cards are identified
• Weekly Eligibility Checks:
  • Implement and perform weekly batch eligibility checks through OneSource to identify lapses in patient coverage promptly.
  • Proactively address eligibility issues to prevent authorization delays and avoid retroactive denialss
• Benefit Verification and Communication:
  • Conduct in-depth validation of both professional and facility benefits for patients, ensuring accurate information is provided at registration.
  • Identify and address discrepancies between professional and facility benefits, including benefit maximums not readily visible on OneSource.
  • Relay verified benefit details to patient advocates, ensuring patients are fully informed of their coverage and responsibilities.
• Continuous Process Improvement and Problem Resolution:
  • Collaborate with the team to refine policies and workflows that enhance claim processing accuracy and patient satisfaction.
  • Provide feedback and insights to leadership regarding recurring issues or opportunities for operational improvements.
  • Generate and analyze reports on authorization trends, denial rates, and account resolution to identify areas for process improvement.
• Revenue Cycle Contribution
  • Ensure accurate and timely documentation of insurance and credit card information to support claims submission, collections and minimize denials.
  • Collaborate with front office teams to resolve discrepancies in patient accounts.
  • Identify and resolve potential revenue cycle issues, such as coverage lapses or claim rejection risks, while services are rendered.

Who You Are:

• Bachelor’s degree in healthcare administration, business, or a related field preferred and/or 2+ years of experience in revenue cycle management, medical billing, or insurance verification.
• Proficiency with Experian or similar eligibility systems.
• Proficiency in Excel
• Strong understanding of insurance policies, coverage verification, and claims processes.
• Exceptional attention to detail and ability to manage multiple priorities.
• Excellent communication skills to work collaboratively with internal teams and external stakeholders.
• Knowledge of behavioral health billing and coding practices (preferred).
• Familiarity with Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) insurance requirement (preferred).