Patient Financial Clearance Representative I

Stanford Health Care

. Complete insurance verification, eligibility, and benefit determinations using electronic eligibility systems, payer websites, and phone .

Posted 10/30/2026full-timeRemote • California • United StatesJunior💰 $34 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in insurance verification, eligibility determination, and authorization processes within a medical organization, while effectively managing patient communications and adhering to compliance standards.

Highest-signal resume keywords

Insurance VerificationEligibility DeterminationAuthorization ProcessesEpic ExperiencePatient Registration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Co-Pay InterpretationDeductible CalculationBenefit DeterminationAuthorization Rules ApplicationData Requirement Assessment

Soft Skills

CommunicationProblem-SolvingCustomer ServiceTime Management

Tools & Technologies

Electronic Eligibility SystemsPayer Websites

Industry Keywords

Medicare Secondary QuestionnairesPeer-To-Peer Appeal ReviewsFinancial CounselingC-I-CARE Standards

About the role

Key responsibilities & impact

Complete insurance verification, eligibility, and benefit determinations using electronic eligibility systems, payer websites, and phone
Interpret and document co-pays, deductibles, share of cost, co-insurance, maximum benefit levels, and available days
Contact patients to obtain and update information
Complete Medicare Secondary Questionnaires as appropriate
Apply authorization rules and requirements for payors in assigned work queues
Develop knowledge of procedures and diagnoses for assigned service lines to complete authorizations
Assess authorization and sponsorship data requirements and communicate with clinics and referring providers
Follow up on pending authorizations and referrals to secure timely sponsorship
Coordinate peer-to-peer appeal reviews with payor utilization management
Prioritize work to minimize financial risk, meet authorization timelines, and achieve daily productivity goals
Identify and escalate coverage, benefit, and financial-clearance risks
Refer cases to financial counseling when authorization is not secured timely
Notify management of errors, issues, or obstacles
Document accounts and communicate through emails, internal notes, and memos
Manage inbound and outbound phone calls and respond to customer inquiries
Assist with special projects and serve as a resource for other payor authorization teams
Perform other assigned duties

Requirements

What you’ll need

High School diploma or GED equivalent
One (1) year working knowledge of patient registration and insurance verification and authorization processes in a medical organization
Epic experience preferred
No licenses or certifications required
Must comply with Stanford Health Care's C-I-CARE patient-experience standards