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UW Medicine Financial Access Clearance Team Services Department (FACT): This position is primarily a full remote/teleworking position within the Financial Access Clearance Team and depending on operational needs, and with proper notice, may be located at any of the following UWM Campuses; Sand Point Non-Seattle Campus (Magnusen Park), Harborview Medical Center (HMC), University of Washington Medical Center (UWMC) or other University of Washington Medicine (UWM) organization non-campus locations.

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.


Work under direct supervision, preforming assigned work. At the start, this position will have an immediate focus on creating good-faith estimates (primarily leveraging Epic’s estimate functionality) in accordance with No Surprise Act (NSA) regulatory requirements. The NSA requires healthcare providers to furnish uninsured and self-pay patients with a good-faith estimate of total out-of-pocket costs for services upon request, or within a specific timeframe after an appointment is scheduled. This position coordinates the insurance clearance process for Inpatient planned and unplanned admits, for Outpatient Surgery, Clinic Procedures, high dollar Infusion, and/or Radiology high dollar Procedures.


Performs the 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.


Under general supervision, the FAS-1 will:

Review scheduled appointments through patient work queue

Obtain insurance authorizations through assigned payer administrators

Verifying/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

Provides internal customers on-going status of inpatient/outpatient authorization from the payer for surgery

Coordinates 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 unclear or other information 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

Requirements:
High School diploma or GED certificate plus one year of experience in a medical office setting. OR Equivalent education/experience.