Department: 16001155 Revenue Cycle Management Business Operations Administration
Shift: Day (United States of America)
Hours: 40
Contract: Non-Union
Weekend Rotation: None
Job Profile Summary: Responsible for completing the financial clearance process and creating the first impression of Allina’s services to patients, their families and other external customers. Articulate information in a manner that patients, guarantors, and family members understand and will know what to expect regarding their financial responsibilities. Works with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial services.
Job Description:

Principle Responsibilities

Perform daily Financial Clearance activities.

• Perform financial clearance processes by interviewing patients and collecting and recording all necessary information for pre-registration of patients
• Educate patients of pertinent policies as necessary i.e., Patient Rights, HIPAA information, consents for treatment, visiting hours, etc.
• Verify insurance eligibility and completes automated insurance eligibility verification, when applicable and appropriately documents information in Epic
• Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure
• Confirm what benefits of a patient’s upcoming visit/stay are covered by the patient’s insurance(s) including exact coverage, effective date of the policy, coverage limitations / requirements, and patient liabilities for the type of service(s) provided
• Provide proactive price estimates and works with patients so they understand their financial responsibilities
• Inform families with inadequate insurance coverage of financial assistance through government and financial assistance programs and refers the patient to financial counseling
• Review and analyzes patient visit information to determine whether authorization is needed and understands payor specific criteria to appropriately secure authorization and clear the account prior to service where possible
• Ensure that initial and all subsequent authorizations are obtained in a timely manner
• May provide mentoring to less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role
• Other duties as assigned.

Job Requirements

• High School or GED required
• Associate's or Vocational degree in Business Administration, Health Care Administration, Public Health, or Related Field of Study preferred
• Less than 2 years experience with Insurance and Benefit Verification, Pre-Registration and/or Prior Authorization activities in healthcare business office/insurance operations preferred
• Experience working with clinical staff. Previous experience working in outpatient and/or inpatient healthcare settings preferred
• Experience working with clinical documentation. Previous experience working with a patients clinical medical record preferred

Leadership Capabilities

• See the Big Picture: Know where we are going as an organization. Use sound judgement and critical thinking to make good decisions that support our mission.
  • I know where Allina is going and how my role fits into this picture
  • I capture important lessons and share them to foster innovation
  • I am good at anticipating the implications of my decisions
  • I understand and apply the disciplines of continuous improvement
• Inspire Greatness: Inspire others by connecting their purpose to the broader mission. Lead others through change and celebrate success.
  • I help my team connect to the broader mission
  • I see and fulfill my role in motivating the team around me
  • I celebrate success and help my partners see what is possible with change
  • I call out and address unexpected roadblocks or problems
• Foster Learning and Growth: Role model growth, ongoing development and self-care. Empower, coach and encourage others to be at their best selves.
  • I role-model self-care and ongoing development
  • I share my knowledge and coach others to foster growth and success
  • I demonstrate enthusiasm for learning
  • I candidly advocate for the resources I need
  • I support my colleagues in their development and growth
• Deliver Excellence: Set and align clear goals, measure results, and continually improve safety, quality, experience, and innovation.
  • I take ownership of outcomes and fulfillment of goals
  • I facilitate adjustments to assure positive results
  • I work with a sense of urgency, concern and determination
  • I use well-grounded approaches to create sustainable solutions repeatedly
  • I engage and foster improvements to impact safety, quality, and efficiency
• Succeed Together: Connect with others authentically. Recognize the value of each individual and seek diverse points of view. Collaborate to succeed together.
  • I consider how decisions might impact my colleagues
  • I am generous in my commitment to supporting the needs of my partners
  • I respect others’ opinions, praise good work and encourage all team members to be involved
  • I seek common ground and work to create mutually beneficial outcomes

Functional Competencies

• Analytical Thinking: Uses basic logic and common sense to arrive at solutions.
• Collaboration: Develops partnerships with internal team members.
• Communication Skills: Able to communicate well in straight-forward situations.
• Company Knowledge: Understands his/her own job and how the role interacts with his/her team.
• Problem Solving: Uses common sense to solve routine issues.

Physical Demands
Sedentary:
Lifting weight Up to 10 lbs. occasionally, negligible weight frequently

Additional Job Description:

Specific job responsibilities of this role involve pharmacy prior authorization processing for retail pharmacy medications and clinic administered infusions and injections. This is a remote position, Must live in MN or WI. Shift hours are 8:30a-5p M-F.