Financial Clearance Specialist II Oncology

Savista•Remote - AL, AL

2d•$19 - $22

About The Position

Processes administrative and financial components of financial clearance including validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out-of-pocket cost share and financial assistance referrals. Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles. Pre-registers patients by obtaining demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing. Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services. Assists Medicare patients with the Lifetime Reserve process where applicable. Reviews previous day admissions to ensure payer notification upon observation or admission. Answer incoming patient or client call/email requests and handle in a prompt/kind, courteous and professional manner. Communicate effectively with patient by simplifying complex information.

Requirements

Proficient knowledge of Medicare, Medicaid MCO Plans, Manage Care and Commercial Insurances as it relates to account receivables
Knowledge of medical terminology, anatomy and physiology, and ICD-10 and CPT/HCPCS code sets
Minimum 3-5 years of experience in health care billing and reimbursement analysis.
Knowledge of medical and insurance terminology.
Excellent verbal communication, telephone etiquette, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.
Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues.
Ability to prioritize work based on criticality and re-prioritize as STAT cases are submitted
Demonstrate dependability, critical thinking, and creativity and problem-solving abilities.
Applies critical thinking skills to identify and resolve problems proactively and identify patient responsibility
Basic working knowledge of UB04 and Explanation of Benefits (EOB).
Knowledge of the Patient Access and hospital billing operations of Epic.
Outstanding organization and time management skills
Proficient computer knowledge including MS Office with ability to enter data, sort and filter excel files
High School Diploma or equivalent

Nice To Haves

Experience in healthcare registration, scheduling, insurance referral and authorization processes
Recent and relevant experience in an active coding production environment strongly
Previous oncology experience preferred, including radiation treatments and general clinical knowledge
Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes
Experience utilizing an encoder system
Experience utilizing EPIC, Cerner, or Meditech systems
Bilingual in English and Spanish
Knowledge of the Patient Access and hospital billing operations of Aria
Bachelor's degree

Responsibilities

Processes administrative and financial components of financial clearance including validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out-of-pocket cost share and financial assistance referrals.
Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles.
Pre-registers patients by obtaining demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing.
Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services.
Assists Medicare patients with the Lifetime Reserve process where applicable.
Reviews previous day admissions to ensure payer notification upon observation or admission.
Answer incoming patient or client call/email requests and handle in a prompt/kind, courteous and professional manner.
Communicate effectively with patient by simplifying complex information.