Clearway Pain Solutions

Representative

• Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions
• Serve as the senior operational liaison across scheduling, eligibility, providers, and operations
• Conduct mandatory introductory calls to patients for assigned procedures and additional calls as needed
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
• Independently re-verify eligibility and benefits when discrepancies are identified
• Provide eligibility confirmation support for payer conflicts, escalations, same-day procedures, emergency procedures, and Medicare add-on procedures
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once procedures are cleared
• Identify potential escalations and patient fallout
• Document communications and escalate issues according to policy
• Serve as the primary contact for initial patient fallout, including hesitation or intent to cancel
• Conduct first-level retention conversations, address insurance/cost/process questions, and provide education and reassurance
• Coordinate handoffs to the Office Manager, Vice President of Operations, or clinical team when patients do not proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email throughout the workday
• Complete required trainings and in-services
• Perform other duties as assigned

Procedure Scheduling Representative II

• Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions
• Serve as the senior operational liaison across scheduling, eligibility, providers, and operations
• Conduct introductory and mandatory calls to patients for assigned procedures
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings and clarify discrepancies
• Independently re-verify eligibility and benefits when discrepancies are identified
• Provide eligibility confirmation support for payer conflicts and escalations
• Support same-day, emergency, and Medicare add-on procedures requiring rapid validation
• Complete mandatory patient calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once cleared
• Identify potential escalations or patient fallout
• Document communications and escalate issues according to policy
• Serve as primary contact for initial patient fallout, including hesitation or intent to cancel
• Conduct first-level retention conversations, address insurance, cost, and process questions, and provide education and reassurance
• Coordinate handoffs to the Office Manager, Vice President of Operations, or appropriate clinical team when patients elect not to proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Complete required trainings and in-services
• Perform other duties as assigned

• Conduct introductory and additional calls to patients for assigned procedures
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
• Independently re-verify eligibility and benefits when discrepancies are identified
• Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations
• Serve as a backup resource for same-day, emergency, and Medicare add-on procedures
• Complete mandatory patient calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once procedures are cleared
• Identify potential escalations or patient fallout
• Document communications and escalate issues per policy
• Serve as the primary point of contact for initial patient fallout
• Conduct first-level retention conversations with patients who express hesitation or intent to cancel
• Address questions regarding insurance, cost, and process, and provide education and reassurance
• Coordinate handoff of patients who decline to proceed to the Office Manager, Vice President of Operations, or appropriate clinical team member
• Exercise confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Complete required trainings and in-services
• Perform other duties as assigned

• Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions
• Serve as the senior operational liaison across scheduling, eligibility, providers, and operations
• Conduct mandatory introductory calls to patients for all assigned procedures
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and assist in resolving escalations
• Independently re-verify eligibility and benefits when discrepancies are identified before scheduling
• Provide eligibility confirmation support for discrepancies, payer conflicts, and escalations
• Support same-day, emergency, and Medicare add-on procedures requiring rapid validation
• Complete patient calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once cleared
• Identify potential escalations or patient fallout
• Document communications and escalate issues per policy
• Serve as the primary point of contact for initial patient fallout, including hesitation or intent to cancel
• Conduct first-level retention conversations to understand concerns, answer insurance, cost, and process questions, and provide education and reassurance
• Escalate cases and coordinate handoff to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients elect not to proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Complete required trainings and in-services
• Perform other assigned duties

• Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions
• Serve as the senior operational liaison across scheduling, eligibility, providers, and operations
• Conduct mandatory introductory calls to patients for all assigned procedures
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
• Re-verify eligibility and benefits when discrepancies are identified before scheduling
• Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations
• Support same-day, emergency, and Medicare add-on procedures requiring rapid validation
• Complete patient calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once procedures are cleared
• Identify potential escalations or patient fallout
• Document communications and escalate issues according to policy
• Serve as primary contact for initial patient fallout, including hesitation or intent to cancel
• Conduct first-level retention conversations, address insurance/cost/process questions, and provide education and reassurance
• Escalate cases and coordinate handoffs to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients do not proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Complete required trainings and in-services
• Perform other duties as assigned

• Conduct introductory calls to patients for all assigned procedures; the first call is mandatory
• Complete additional patient calls as needed based on professional judgment
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and assist in resolving escalations
• Independently re-verify eligibility and benefits when discrepancies are identified
• Provide eligibility confirmation support for discrepancies, payer conflicts, and escalations
• Act as a backup resource for same-day, emergency, and Medicare add-on procedures
• Complete mandatory calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once cleared
• Identify potential escalations or patient fallout
• Document all communication and escalate issues per policy
• Serve as the primary point of contact for initial patient fallout
• Conduct first-level retention conversations to understand concerns, address insurance, cost, or process questions, and provide education and reassurance
• Escalate cases and coordinate handoff to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients elect not to proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Complete required trainings and in-services
• Perform other duties as assigned

Billing Specialist

• Support complete and timely collection of revenue for assigned groups
• Accurately code and enter patient and charge information into the billing system
• Follow up on outstanding claims and charges
• Review and resolve payer denials, including appeals, coding corrections, and medical necessity rules
• Analyze and resolve billing issues while keeping accounts receivable to no more than 10% over 60 days
• Process daily correspondence and claim status; handle denials, appeals, and re-bills
• Answer billing questions from patients and internal staff
• Update patient files with address and contact information changes
• Review policy changes and inform the supervisor and charge entry specialist
• Navigate insurance company proprietary websites to find policies and research payments
• Keep the supervisor informed about accounts receivable matters
• Respond to billing company requests in a timely manner
• Research denials and submit corrected claims and medical documentation
• Review and manage claims in work-dashboard hold buckets
• Create, maintain, and update reports as directed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Complete required trainings and in-services
• Perform other duties as assigned

Patient Navigator

• Manage complex procedures, high-end ASC cases, first-level escalations, and eligibility exceptions
• Serve as the senior operational liaison across scheduling, eligibility, providers, and operations
• Conduct mandatory introductory calls to patients for assigned procedures and additional calls as needed
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
• Re-verify eligibility and benefits when discrepancies are identified before scheduling
• Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations
• Support same-day, emergency, and Medicare add-on procedures requiring rapid validation
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once procedures are cleared
• Identify potential escalations or patient fallout
• Document communications and escalate issues according to policy
• Serve as the primary point of contact for initial patient fallout
• Conduct first-level retention conversations, address insurance/cost/process questions, and provide education and reassurance
• Coordinate handoffs to the Office Manager, Vice President of Operations, or clinical team when patients elect not to proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Complete required training and in-services
• Perform other duties as assigned

Patient Navigator II

• Support complete and timely collection of revenue for assigned groups
• Accurately code and enter patient and charge information into the billing system
• Follow up on outstanding claims and charges
• Review and resolve payer denials, including appeals, coding corrections, and medical necessity rules
• Analyze and resolve billing issues, keeping accounts receivable to no more than 10% over 60 days
• Process daily correspondence and claim status; handle denials, appeals, and re-bills
• Answer billing questions and inquiries from patients and internal staff
• Update patient files with address and contact information changes
• Review policy changes and inform the supervisor and charge entry specialist
• Navigate insurance companies' proprietary websites to find policies and research payments
• Keep the supervisor apprised of accounts receivable matters
• Respond to billing company requests in a timely manner
• Research denials and submit corrected claims and medical documentation
• Review and manage claims in work-dashboard hold buckets for resolution
• Create, maintain, and update reports as directed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Participate in and complete required trainings and in-services
• Perform other duties as assigned

• Conduct introductory and additional calls to patients for assigned procedures
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and assist with escalations
• Re-verify eligibility and benefits when discrepancies are identified
• Provide eligibility confirmation support for payer conflicts, escalations, same-day procedures, emergency procedures, and Medicare add-on procedures
• Complete mandatory patient calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once procedures are cleared
• Identify potential escalations and patient fallout
• Document communications and escalate issues according to policy
• Serve as the primary contact for initial patient fallout, including hesitation or intent to cancel
• Conduct first-level retention conversations, address insurance, cost, and process questions, and provide education and reassurance
• Escalate cases and coordinate handoffs to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients do not proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email throughout the workday
• Complete required trainings and in-services
• Perform other duties as assigned

• Support complete and timely collection of revenue for assigned groups
• Perform accurate coding and entry of patient and charge information into the billing system
• Follow up on outstanding claims and/or charges
• Review and resolve payer denials, including appeals, coding corrections, medical necessity rules, and related functions
• Analyze and resolve billing issues, keeping A/R to no more than 10% over 60 days
• Process daily correspondence and claim status; handle denials, appeals, and re-bills
• Answer billing questions and inquiries from patients and internal staff
• Update patient files with address and contact information changes
• Review policy changes and inform the supervisor and charge entry specialist
• Navigate assigned insurance companies' proprietary websites to find policies and research payments
• Keep the supervisor apprised of accounts receivable matters
• Respond to billing company requests in a timely fashion
• Research denials and submit correct claims and medical documentation
• Review and manage claims in work dashboard hold buckets for resolution
• Create, maintain, and update reports as directed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Participate in and complete required trainings and in-services
• Perform other duties as assigned

• Conduct introductory calls to patients for all assigned procedures; the first call is mandatory
• Complete additional patient calls as needed based on professional judgment
• Serve as the onshore liaison to the offshore eligibility and pre-certification team
• Review eligibility and authorization findings, clarify discrepancies, and resolve escalations
• Independently re-verify eligibility and benefits when discrepancies are identified before scheduling
• Provide eligibility confirmation support for payer conflicts, discrepancies, and escalations
• Serve as a backup resource for same-day, emergency, and Medicare add-on procedures
• Complete mandatory calls within SLA
• Communicate authorization status and timelines
• Explain out-of-pocket costs and collect deposits
• Finalize scheduling once procedures are cleared
• Identify potential escalations or patient fallout
• Document communications and escalate issues according to policy
• Serve as the primary point of contact for initial patient fallout, including hesitation or intent to cancel
• Conduct first-level retention conversations, address insurance, cost, and process questions, and provide education and reassurance
• Escalate cases and coordinate handoffs to the Office Manager, Vice President of Operations, or appropriate clinical team member when patients do not proceed
• Maintain confidentiality and comply with HIPAA rules and regulations
• Check and respond to work email regularly throughout the workday
• Participate in and complete required trainings and in-services
• Perform other duties as assigned

Attorney

• Coordinate and support personal injury department functions related to medical records and billing
• Initiate medical records by creating and processing patient cases
• Retrieve medical records through chart exporting and document retrieval issues for statistical and follow-up purposes
• Deliver charts/requests to assigned personnel or company
• Communicate record availability or unavailability to healthcare providers, requesters, and attorneys
• Document and communicate actions, irregularities, and continuing needs to maintain work continuity
• Maintain confidentiality of patient records and comply with HIPAA rules and regulations
• Forward records to third-party vendors as necessary
• Call patients to gather information
• Verify auto insurance and contact attorneys for policy limits and accident details
• Verify patients' personal health insurance
• Contact patients to schedule or transfer scheduling to patient access after clearance
• Create billing statements for Clearway Pain and Clearway Surgery Center
• Verify billing balances against patient accounts and send statements to requested parties
• Confirm insurance payments and verify balances after posting
• Establish points of contact with attorneys' offices and patients
• Check work email regularly throughout the workday
• Participate in and complete required trainings and in-services
• Perform other assigned duties

Legal Liaison

• Coordinate and support the personal injury department's medical records and billing functions
• Initiate medical records by creating and processing patient cases
• Retrieve medical records through chart exporting and document unretrievable charts for statistical and follow-up purposes
• Deliver charts and requests to assigned personnel or company
• Communicate record availability or unavailability to healthcare providers, requesters, and attorneys
• Document and communicate actions, irregularities, and continuing needs
• Maintain confidentiality of patient records and comply with HIPAA rules and regulations
• Forward records to third-party vendors as necessary
• Contact patients to gather information
• Verify auto insurance, personal health insurance, insurance payments, and balances
• Contact attorneys to gather policy limit information and accident details
• Schedule patients or transfer scheduling to patient access after clearance
• Create billing statements for Clearway Pain and Clearway Surgery Center
• Verify billing balances and send statements to requested parties
• Establish points of contact with attorneys' offices and patients
• Check work email regularly throughout the workday
• Complete required training and in-services
• Perform other assigned duties

• Coordinate and support personal injury department functions related to medical records and billing
• Initiate medical records by creating and processing patient cases
• Retrieve medical records through chart exporting and document retrieval issues for statistical and follow-up purposes
• Deliver charts/requests to assigned personnel or company
• Communicate record availability or unavailability to healthcare providers, requesters, and attorneys
• Maintain continuity of operations by documenting and communicating actions, irregularities, and continuing needs
• Maintain confidentiality of patient records and comply with HIPAA rules and regulations
• Forward records to third-party vendors as necessary
• Call patients to gather information
• Verify auto insurance, personal health insurance, insurance payments, and balances
• Contact attorneys to gather policy limit information and accident details
• Schedule patients or pass them to patient access for scheduling once complete and cleared
• Create billing statements for Clearway Pain and Clearway Surgery Center
• Verify billing balances against patient accounts and send statements to requested parties
• Establish points of contact with attorney offices and patients
• Check work email regularly throughout the workday
• Participate in and complete required trainings and in-services
• Perform other duties as assigned