Title: Inpatient Financial Clearance Representative I

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing.  In addition, this role focuses on performing the following Patient Access duties: Performs the administrative and financial-clearance duties necessary to facilitate the procurement of clinical services by patients. Collects patient's necessary demographic and financial information from physician offices, acute-care entities, or the patients themselves, schedules services for patients, and handles referrals from primary care doctors to ensure patients are scheduled for recommended appointments/procedures, etc.    An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment.  The majority of time is spent in the delivery of support services or activities, typically under supervision.  An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is closely supervised, and communicates information that requires little explanation or interpretation.

Job Overview

The position is responsible for obtaining notification and verification of benefits with all insurance carriers for urgent inpatient and observation admissions. Financially secures each account and escalates financial clearance concerns through prompt and closed-loop communication. Collaborates and reviews financial clearance data with Supervisor and Manager to ensure proper notification for all services.  

Job Description

Minimum Qualifications:

1. HS diploma or equivalent . 

2. Two (2) years of experience in a hospital, physician, or financial setting

Preferred Qualifications:

1. Three (3) years of experience in a hospital, physician, or financial setting

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned.

1.Contacts insurance companies to obtain verification of insurance, eligibility, and level of benefits. Notifies all payers timely based on admission date. Enters benefit information into hospital computer systems. 

2.Obtains financial data from a variety of sources including domestic and international coverages.  Successfully completes timely notifications for all payers regardless of method. Methods of notification could include phone call, fax, or payer portals.

3.Notifications may include submitting Notification of Birth for newborns being added to Medicaid policy.

4.Confirms correct coordination of benefits when more than one insurance carrier is involved. 

5.Updates financial/insurance plan codes within hospital computer systems according to eligibility responses.  

6.Enters notification information and proper documentation into hospital computer systems.  

7.Identifies procedures & services that are not covered services by individual insurance policies.  Refers all identified financial risk concerns to the department.

8.Collaborates with Financial Counseling colleagues regarding patients with identified financial risk concerns for resolution. 

9.Immediately identifies denied claims and works closely with department leaders, coordinators and clinical team members towards their appeal.

10.Reviews all WQs assigned to IPFC and ensures accounts are completed timely.

11.Acts as a resource to other departments of the hospital regarding notification policies and resolution of accounts. 

12.Communicates clearly to Tufts MC team members and leadership status of financially at-risk cases and resolution steps. Closely monitors at risk cases and provide timely updates.

13.Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group’s achievement of goals, and to help foster a positive work environment.

14.Works closely with Case Management and Admitting colleagues to confirm level of care changes, particularly for urgent admissions, and communicates level of care upgrades or downgrades with payers within a timely manner.

15.Learns workflow changes and updates as they occur in real-time and maintains an openness to adopt updated workflows.

16.Assists in the training and shadowing of new team members.

17.Supports Supervisor and Team with procedures and policies

Physical Requirements:

1.Frequent sitting, occasional standing & walking, and lifting of 5-10 lbs.  

2. Mental requirements will be intense at times with involvement in many concurrent multi-faceted projects.

3. Requires manual dexterity using fine hand manipulation to operate a computer keyboard or related equipment

4. Requires ability to see computer screen, monitoring equipment and reports

Skills & Abilities:

1.Thorough working knowledge and willingness to learn computer systems.

2.Strong verbal and written communication skills.  Must demonstrate a patient service focus. 

3.Excellent organizational skills and ability to prioritize work assignments.  Ability to respond effectively to changing priorities and work processes. 

4.Ability to work independently and participate in teams

5. Basic excel knowledge and reporting

6.Ability to recognize and deal with problematic situations, set priorities, make effective decisions, and respond quickly

At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.

The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.

Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth—one of the many ways we invest in you so you can thrive both at work and outside of it.

Pay Range:

based on full-time equivalent