Financial Clearance Specialist

The Financial Clearance Specialist is responsible for obtaining precertification/ prior authorization for inpatient admissions, surgical procedures, and outpatient clinical services. The Financial Clearance Specialist secures financial clearance for each admission in accordance to payer guidelines and escalates financial clearance concerns through prompt and closed loop communication. Collaborates and reviews financial clearance data with the Patient Access Supervisor and Manager to ensure proper authorization for all services is obtained. The Financial Clearance Specialist is responsible for verification of insurance benefits with all insurance carriers.

Responsibilities

Obtaining precertification/ prior authorization for inpatient admissions, surgical procedures, and outpatient clinical services; Securing financial clearance for each admission in accordance to payer guidelines; Escalating financial clearance concerns through prompt and closed loop communication; Collaborating and reviewing financial clearance data with the Patient Access Supervisor and Manager to ensure proper authorization for all services is obtained; Verification of insurance benefits with all insurance carriers; Working independently to complete daily assignments by the end of the shift and long term assignments by established deadline; Meeting management targets for authorization accuracy rates and falling within the standard of no greater than five administrative denials; Adhering to current department processes and all South Shore Health and external policies and/or procedures which may affect reimbursement; Collaborating with internal and external stakeholders to achieve best outcome for patients and the health systems revenue cycle; Collecting, verifying, and recording all patient demographic and insurance information required per hospital policy; Ensuring all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved using RTE and Passport OneSource; Adhering to identifying accurate patient information; Determining, providing, and collecting patient out of pocket costs when applicable, including copayments and estimates; Identifying and transcribing ICD-10 diagnosis and procedure CPT codes; Navigating computer software systems to adhere to department standards; including EPIC, Workday, insurance verifications portals, API (timecard), and Medicare/Medicaid systems; Managing assignments by utilizing Faxcom programming and manual faxing to external vendors; Participating in continued learning and possessing a willingness and ability to learn and utilize new technology and procedures; Embracing technological advances that allow us to communicate information effectively and efficiently based on role and complying with all regulatory agencies; Maintaining the confidentiality and privacy of protected health information consistent with HIPAA requirements at all times; Observing hospital and department policies and procedures; Maintaining a high level of accuracy of all information conveyed in an authorization request and addressing errors in a timely fashion; Understanding the impact that data collected has on hospital operations; Adhering to universal precautions and respiratory etiquette guidelines

Requirements

High school diploma; Minimum one (1) year Financial Clearance experience to become proficient; Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) coding and International Classification of Diseases (ICD-10); Knowledge of payer policies for medical necessity/authorization requirements; Ability to work independently with minimal need for supervision; Ability to work in a fast paced environment to ensure completion of daily caseload within appropriate time frames; Positive attitude and strong desire to positively contribute to the team; Knowledge of hospital EHR systems in EPIC; Ability to identify, analyze and resolve problems and situations quickly and effectively; Strong knowledge of overall Revenue Cycle operations related to healthcare; Medical terminology; Insurance Knowledge; Computer skills; Strong knowledge of third party insurance required; Ability to follow through and troubleshoot; Attention to detail; Customer Service skills; Organizational skills; Ability to work well within a team.

Nice to have

Two (2) years of college