Financial Clearance Analyst

Cape Cod Healthcare•Hyannis, MA

About The Position

Troubleshoot and evaluate Patient Access department workflows, make recommendations to management, and implement changes. Participate with management in strategizing for Process Improvement initiatives. Attend and participate in management meetings related to oversight of Patient Access Staff and third party vendors. Provide input and feedback for employee evaluations and make recommendations to management for productivity improvement opportunities. Be fully knowledgeable about all aspects of insurance verification and prior authorization requirements. Monitor and track denials originating from patient access and financial clearance areas and look to improve workflows to reduce the volume. Oversees and supports the processes around scheduled patients without insurance coverage in relation to Revenue Cycle operational goals. Perform ongoing Quality Assurance analysis of HB & PB Workqueues with Registration and Authorization owning area. Recommend strategies to deal with problems that get identified during this process and implement agreed upon corrections. Regularly updates knowledge of third party payor regulations, and updates staff in writing of any changes as they become known. Supports the prior authorization workflows and process with knowledge of prior authorization requirements and strategies for obtaining. Responsible for making sure that we stay current on industry changes, adapt our processes to meet these changes and ensure that our Business Office runs smoothly as the result of having finely tuned financial clearance and scheduling processes. Regularly updates knowledge of state and federal regulations to ensure compliance around providing patient estimates. Utilize programs such as Experian OneSource, AIM, Eversource, and individual payer websites to identify and verify insurance coverage for patients. Works in collaboration with other CCH departments to improve the revenue cycle process in an effort to improve processes that enhance service and patient relations. Perform other work related duties as assigned or requested. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers. Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

Requirements

Associate degree required, BA or BS desired.
Minimum of 3 – 5 years’ experience in a large hospital’s Revenue Cycle and/or Patient Access Department with an emphasis on Scheduling and Financial Clearance strongly preferred.
Experience with large hospital information systems is preferred, preferably Epic.
Expert computer skills with an emphasis on MS Office programs and data analysis required.
Expert verbal and written communication skills are required.

Nice To Haves

BA or BS desired.
Experience with large hospital information systems is preferred, preferably Epic.
Minimum of 3 – 5 years’ experience in a large hospital’s Revenue Cycle and/or Patient Access Department with an emphasis on Scheduling and Financial Clearance strongly preferred.

Responsibilities

Troubleshoot and evaluate Patient Access department workflows, make recommendations to management, and implement changes.
Participate with management in strategizing for Process Improvement initiatives.
Attend and participate in management meetings related to oversight of Patient Access Staff and third party vendors.
Provide input and feedback for employee evaluations and make recommendations to management for productivity improvement opportunities.
Be fully knowledgeable about all aspects of insurance verification and prior authorization requirements.
Monitor and track denials originating from patient access and financial clearance areas and look to improve workflows to reduce the volume.
Oversees and supports the processes around scheduled patients without insurance coverage in relation to Revenue Cycle operational goals.
Perform ongoing Quality Assurance analysis of HB & PB Workqueues with Registration and Authorization owning area. Recommend strategies to deal with problems that get identified during this process and implement agreed upon corrections.
Regularly updates knowledge of third party payor regulations, and updates staff in writing of any changes as they become known.
Supports the prior authorization workflows and process with knowledge of prior authorization requirements and strategies for obtaining.
Responsible for making sure that we stay current on industry changes, adapt our processes to meet these changes and ensure that our Business Office runs smoothly as the result of having finely tuned financial clearance and scheduling processes.
Regularly updates knowledge of state and federal regulations to ensure compliance around providing patient estimates.
Utilize programs such as Experian OneSource, AIM, Eversource, and individual payer websites to identify and verify insurance coverage for patients.
Works in collaboration with other CCH departments to improve the revenue cycle process in an effort to improve processes that enhance service and patient relations.
Perform other work related duties as assigned or requested.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.