FINANCIAL CLEARANCE REPRESENTATIVE

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Central Maine Healthcare
Published
January 22, 2021
Location
Lewiston, Maine
Job Type

Description

FINANCIAL CLEARANCE REPRESENTATIVE

Patient Contact Center
FT
Day shift
8am-4:30pm
Req #: 29067
Position Summary:  The Financial Clearance Representative (FCR) is responsible to ensure patients presenting for services are financially cleared prior to service.  This is to include pre-registration, validating eligibility and benefits, referral, prior authorization, price estimating, obtain or provide payment options pre-service and communicating with the patient and/or collaborating with the practice or department.
Essential Duties: 
The Financial Clearance Representative (FCR) is responsible to complete validation process prior to service which includes full pre-registration, eligibility, benefit verification and price estimator, contacting insurance plans to obtain prior authorization and medical policies.  Process referrals and prior authorizations within 24-48 hours of receipt of the task.  FCR is responsible to accurately document and report completions of process following standard work of Financial Clearance. FCR is responsible to identify, interpret and communicate findings that do not meet financial clearance criteria. FCR is responsible to communicate to the appropriate department, practice or provider when key data elements including medical necessity are missing or not met that require review to continue with the clearance process. FCR is responsible to communicate payment risk and collaborate with Financial Counselors to complete the financial clearance process.   The FCR is responsible to engage management when issues or concerns result in failure to meet deadlines or financial clearance expectations.
Education and Experience:
High School graduate
Minimum of three years relevant or medical office experience
Health insurance knowledge
Knowledge of medical terminology preferred
Knowledge, Skills and Abilities:
Strong computer skills including navigating various websites, and applications
Strong problem solving skills
Microsoft Office
Effective communication both verbal and written
Ability to work collaboratively
Candidate will continue to meet and complete ongoing training enhancing skills needed in this position.
OUR PURPOSE & VALUES:
Our mission is to provide exceptional healthcare services in a safe and trustful environment through expertise, commitment and compassion of our team members, with the vision of safe, reliable, high quality care for each patient, every day.
How do we make this happen? By creating and maintaining a culture where our values of compassion, integrity, citizenship, service excellence and community are lived out in observable behaviors during all interactions.
ABOUT CENTRAL MAINE HEALTHCARE:
Central Maine Healthcare (CMH) is an integrated healthcare delivery system serving 400,000 people living in central, western, and mid-coast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital, and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center, and other high quality clinical services.
About Central Maine Medical Center
Central Maine Medical Center (CMMC) located in Lewiston, is a Level II Trauma Center serving Androscoggin County and the surrounding region. "CMMC's Centers of Excellence" include the Central Maine Heart and Vascular Institute, the Central Maine Comprehensive Cancer Center, the Neonatal Intermediate Care Unit, and a Trauma Services Program. CMMC is also the southern Maine base for LifeFlight of Maine, the state's only medical helicopter service. Supported by the latest technologies, CMMC's skilled professionals provide outstanding care delivered with compassion, kindness, and understanding. Learn more at: www.cmmc.org.
About Bridgton Hospital
Part of Central Maine Healthcare, Bridgton Hospital serves the town of Bridgton and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. Bridgton Hospital was named as one of 17 top rural hospitals in the nation for the third consecutive year in 2018.
About Rumford Hospital
Part of Central Maine Healthcare, Rumford Hospital serves the town of Rumford and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. In 2018, Rumford Hospital was named one of 17 top rural hospitals in the nation by the Leapfrog Group; in 2016, it was designated a Pathway to Excellence® organization by the American Nurses Credentialing Center. Learn more at: www.rumfordhospital.org.
Central Maine Healthcare is equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.
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