Financial Clearance Specialist

American Addiction Centers•Winston-Salem, NC

1d•$23 - $34•Onsite

About The Position

The Financial Clearance Specialist is responsible for obtaining necessary reports, confirming insurance eligibility and benefits, and verifying demographic and insurance information. This role also involves verifying Medicare accounts, determining pre-certification needs, calculating and collecting patient liability, and maintaining compliance with HIPAA regulations. The specialist will also develop and maintain knowledge of insurance plans and contract requirements, and participate in professional development to stay current with industry changes.

Requirements

High school diploma or GED equivalent
Two years' work experience in registration, financial clearance or patient financial services
Strong working knowledge of healthcare insurance and benefit programs
Excellent knowledge of applicable rules and guidelines governing traditional insurance coverage and reimbursement
Excellent interpersonal skills
Effective oral and written communication skills
Creative problem solving
Strong working knowledge of applicable rules, regulations and guidelines governing managed care coverage and reimbursement

Nice To Haves

Associate's or Bachelor's degree in Health Administration or Business Administration

Responsibilities

Obtains all reports needed to begin insurance verification process that are outside of the Epic work queues.
Confirms eligibility and secures full benefits coverage information, including COBRA when applicable, with insurance companies and employers.
Confirms all demographic information is correct i.e. policyholder's name, date of birth, ID, policy numbers, group name and group number. Assures coordination of Benefits (COBs) and insurance plan codes are accurate.
Verifies Medicare accounts, cross-referencing traditional Medicare and other providers as required. Utilizes all websites and phone as needed. Determines number of prior Medicare days using history from both within and outside our facility. Reviews system to determine if appropriate APC (inpatient versus outpatient) status is correct. Notifies the physician office if the admit status needs to be changed.
Verifies insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons.
Determines if pre-certification, pre-authorization or referral is required by providing ICD-9 and CPT codes to the insurance company.
Contacts referring physician or other appropriate staff when service is not authorized. Escalates all unauthorized services to management for review and next steps, including delay and reschedule. Communicates with provider regarding out-of-network issues and documents outcomes and next steps.
Calculates, communicates and collects the patient liability prior to service. Conducts all transactions consistent with cash management policies and procedures. Maximizes collection of money by estimating patient liabilities and requesting collection of co-payments and other personal balances prior to or at the time of service. Refers patients to Financial Counselors for assistance as appropriate.
Completes Medicare Secondary Questions accurately with the patient or patient's representative.
Reviews, takes necessary follow up steps and rectifies accounts held due to claim edits to ensure timely submission for billing.
Maintains compliance with HIPAA regulations as it pertains to the insurance process.
Develops and maintains knowledge and skills to identify insurance plans correctly in system, understands contract requirements and maintains accurate insurance information.
Maintains professional development by attending workshops, in-services and webinars to remain up-to-date on insurance rules, regulations in addition to the internal and external changes within the industry.
Performs other duties as assigned.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program