Job description

One of the tri-state's Premier Medical Center's is seeking a Financial Clearance Specialist, that will be work directly with referring physician offices, payers, and patients to ensure full detailed audits of patient's data capture and financial responsibilities prior to the provision of care. The ideal candidate will have experience with Insurance Verification, Medical Billing, and/or Prior Authorization’s.

• Position: Financial Clearance Specialist (Healthcare)
• Location: Norwalk, CT
• Schedule: Monday – Friday / flexible start/end time 8a/9a – 4p/5p
• Salary: Depends on years of experience, $48k - $70k+ (annually) or $25-$35 (hourly)

Summary: We have an exciting opportunity to join our team as a Financial Clearance Specialist. In this role, the successful candidate under the general direction of the Revenue Cycle Operations (RCO) Director. The Financial Clearance Specialist (FCS) is responsible for performing accurate and timely insurance clearance functions pre and post service to ensure maximum hospital reimbursement and mitigate insurance denials.

Health system responsibilities for the FCS include, but are not limited to:

• Verifying insurance eligibility and determining patients’ insurance coverage and insurance authorization requirements,
• Obtaining and documenting pre-authorizations and pre-certifications.
• Verifying coverage levels.
• Utilizes Meditech PCS Transfer Queue Estimate tool to calculate patients estimated hospital financial responsibility and ensure Out of Pocket (OOP) amounts are communicated to the patient pre-service.
• Working cases timely and efficiently from the Meditech PCS Transfer Queue.
• Collecting pre-service time of payments.
• Providing exceptional customer service to both internal and external stakeholders and facilitating RCO and patient financial needs.

Job Responsibilities:

• Responsible for communicating to service line partners of situations where rescheduling is necessary due to lack of authorization and / or limited benefits and is approved by clinical personnel based on defined service level agreements.
• Validates scheduled procedures pass medical necessity verification where appropriate and notifies where Advanced Beneficiary Notices (ABNs) must be gathered from patients in advance if the supplied diagnoses information fails.
• This position is responsible and accountable for the timely and accurate insurance clearance of pre and post inpatient and outpatient accounts from Meditech PCS Transfer Queue as assigned.
• Performs insurance benefits verification to confirm eligibility for scheduled or prospective services.
• Reviews for appropriate coordination of benefit and identifies discrepancies prior to clearance.
• Determines insurance authorization requirements for services scheduled or received.
• Ensures all scheduled services are authorized and appropriate notification and/or referral is obtained prior to the date of service to ensure payment for services.
• Ensures clear and timely documentation of all insurance clearance activities and outcomes, including authorization information in Meditech.
• Performs all required follow-up to secure authorization pre-service, including follow-up with providers’ offices, scheduling departments and insurance companies.
• Performs medical necessity review for applicable services to ensure diagnosis is covered under insurance carrier clinical bulletin policy for outpatient appointments as scheduled.
• Determines patients’ benefit level based on in-network or out-of-network benefits.
• Identifies non-par plan status and follows appropriate out of network workflow based on service and payor type. Calculates and communicates patients estimated out of pocket hospital financial responsibility pre-service for scheduled or prospective services utilizing the Meditech Estimator tool or International Calculator.
• Understands performance measures and is accountable for meeting monthly target goals as determined based on service and payer.
• Exercises skill in prioritizing assignments to complete work in a timely manner when there are changes in workload, assignments, and pressures of deadlines, competitive requirements and/or a heavy workload.
• Demonstrates optimal customer service skills when interfacing with patients, patients’ families, physicians, physician office staff, and hospital colleagues.
• Demonstrates excellent communication skills; uses appropriate vocabulary and grammar when obtaining and conveying information to physicians, nurses, and staff at various levels; in person, over the phone, in writing and in electronically sent messages.
• Works collaboratively with and acts as a liaison with a variety of internal departments within our Medical Center, external business partners, external departments, and our contracted payers.
• Works independently, takes initiative, and escalates to leadership appropriately.
• Responsible for answering and redirecting phone calls as needed and responding to emails timely.
• Adhere to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required trainings, and other Hospital mandated activities.
• Perform other duties as assigned.

Minimum Qualifications:

• To qualify you must have a High School Diploma and 1-year experience in patient accounts or a related field or an equivalent combination of education and experience.
• Strong knowledge of front-end hospitals, medical office, patient access, revenue cycle and /or practice operations. Knowledge of medical and insurance terminology.
• Knowledge of insurance benefit verification tools including payor portals, RTE, etc.
• Ability to perform with accuracy and attention to detail for meeting payer-imposed deadlines daily.
• Ability to compose and edit logical, detailed, comprehensive, and grammatically correct correspondence.
• Ability to communicate effectively with a wide variety of personnel including patients, families, physicians, and staff.
• Experience and competency with varied computer hardware and software, including registration and billing systems, word processing, spreadsheet, database, scheduling, communications.
• Ability to handle matters of a highly confidential and sensitive nature.
• Ability to recognize and identify problems, recognize implications, and propose alternative solutions. Skill in prioritizing assignments to complete work in a timely manner. Skill in working independently and in following through on assignments with minimal direction.

Preferred Qualifications:

• Associate degree plus 2-3 years of experience in hospital admissions, patient accounts or medical records or in related field.
• EMR Software experience.
• Qualified candidates must be able to effectively communicate with all levels of the organization.

Job Type: Full-time

Pay: $48,000.00 - $70,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No weekends

Ability to commute/relocate:

• Norwalk, CT: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Customer service: 1 year (Preferred)
• Microsoft Word: 1 year (Preferred)

Work Location: In person

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