Coordinator - Financial Clearance

HonorHealth•Phoenix, AZ

15h•Remote

About The Position

Under Pre-Services/Pre-Registration Leadership, the Coordinator performs financial clearance functions for hospital ancillary outpatient appointments. The role supports denial prevention and the organization’s financial goals by obtaining and documenting patients’ insurance benefits and eligibility, securing prior authorizations, and validating and interpreting medical necessity results using payer-specific policies or criteria and web-based medical necessity software. The Coordinator creates Commercial Waivers and Medicare ABNs when necessary and contacts patients about insurance benefits and authorization status, or to discuss eligibility, medical necessity, or prior authorization issues. The position works with referring physician offices and hospital departments to reduce denials and obtain authorizations on time. Accurate and timely documentation of insurance, eligibility, authorization, interactions, and other relevant information in the patient EMR is required according to department standards. This is a work-from-home position that may require commuting to NSSC for staff meetings, training, and occasional one-on-one meetings with the Supervisor. Occasional overtime may be required.

Requirements

High school diploma or GED required.
Basic knowledge of health insurance plans and requirements, and knowledge of hospital outpatient departments and services offered, required.
Typing speed of at least 45 words per minute required.
One year of experience in a healthcare field required, including a medical office, insurance/front desk, medical insurance prior authorization, hospital registration, ancillary or surgical procedure scheduling, hospital business office billing or collections, or medical insurance company provider services or prior authorization departments.

Nice To Haves

Associate's degree preferred.

Responsibilities

Manage prior authorization, insurance eligibility and benefits, and medical necessity for patients served by hospital ancillary departments.
Obtain insurance eligibility and benefits using Real Time Eligibility (RTE), payer websites, or calls to payers when necessary.
Review payer-specific medical policies or criteria to interpret medical necessity results using the web-based medical necessity tool.
When necessary, review or request clinical documentation from referring physicians to substantiate medical necessity and submit it to payers with prior authorization requests.
Request and secure prior authorization for scheduled ancillary services and validate and interpret medical necessity before the date of service, according to department standards.
Provide benefit, eligibility, prior authorization, and medical necessity results to patients, hospital ancillary department staff, and referring physicians as needed, requested, or required.
Answer inbound calls and make outbound calls to patients, referring physician offices, insurance plans, ancillary departments, and others regarding HonorHealth patients or related inquiries.
Respond promptly and professionally to concerns from patients, staff, and others involved in patient care while maintaining a respectful demeanor.
Follow HonorHealth, Pre-Services, and Patient Access policies and procedures; communicate clearly, effectively, and respectfully; and adhere to HonorHealth ICARE values and Employee Standards of Conduct.
Document new or updated patient and insurance plan information in the EMR promptly and according to department standards.
Document interactions and information regarding scheduled appointments, benefits, eligibility, and prior authorization in the EMR according to department standards.
Facilitate problem-solving with ancillary departments, providers, referral sources, or patients as needed.
Assist with maintaining, communicating, and documenting payer information changes relevant to patient needs, prior authorization, benefits, and medical necessity.