The FINANCIAL ACCESS SPECIALIST 1 (FAS 1) will, under general supervision, participate in on-the-job training to learn to coordinate the insurance clearance process for Inpatient planned and unplanned admits, for Outpatient Surgery, Clinic Procedures, high dollar Infusion, and/or Radiology high dollar Procedures, as well as, various functions associated with obtaining and verifying the insurance coverage and benefits for facility and professional services, which may include emergency services, inpatient hospitalization, transportation, rehab, therapies, nursing home placement, home health care/durable equipment, outpatient surgeries, clinical visits, and specialized procedures; also verifies L&I, Crime Victims and other coverages.

RESPONSIBILITIES:

The FINANCIAL ACCESS SPECIALIST 1 will:

• Review scheduled appointments through patient work queue
• Obtain insurance authorizations through assigned payer administrators
• Verify/document patients eligibility and benefits in Epic auth/cert
• Document progress of each case in Epic auth/cert
• Refer uninsured patients for Medicaid/Charity eligibility screening
• Prepare estimates of fees upon request from Patient Care Consultants
• Review payment options with patients
• Keeps daily productivity log as assigned
• Provides internal customers on-going status of inpatient/outpatient authorization by payer
• Collect payments
• Process payments using cash drawer in Epic
• Call patients to provide overview of limited medical benefits and Out-of-
• Pocket cost
• Prepare Notice of Non-Coverage form for patient signature
• Call referring providers to obtain referrals or to initiate authorization
• Provide internal customers on-going status of inpatient/outpatient authorization from the payer for surgery
• Coordinate and explains options to patients related to potential financial
  responsibilities including charity/financial assistance, possible Medicaid eligibility, financial implications of proceeding with or without authorizations, and in and out-of-network ramifications
• Confer with Financial Clearance supervisor if coverage status is unclear or other information is unclear
• Interpret hospital’s policies, procedures and services to patients, patient representatives, inter/intra-hospital departments and community facilities
• Ensures patient demographic information is accurate in EPIC and REG, through patient contact or insurance verification information
• Verify eligibility of patient’s insurance and document information.
• Verify patient benefits and document information.
• Verify or obtain an referral when it is required, prior to the service