Financial Clearance Specialist - Corporate Business Services
About The Position
The Financial Clearance Specialist ensures that payers are prepared to reimburse Corporate Business Services (CBS) for scheduled services in accordance with payer-provider contracts. The role supports care planning by understanding how patients’ benefits relate to services and keeping patients and physicians informed while seeking payer authorizations. The specialist provides financial clearance for transplant, surgical, chemotherapy, and radiation therapy patients. Duties include insurance verification, price estimation, validation of medical necessity for certain services, determining benefit and coverage levels, and connecting patients with financial assistance resources when needed. The role requires a proficient understanding of third-party payer regulations and guidelines for these service lines, including medical necessity requirements for pharmaceuticals and recurring services. The specialist is expected to provide a high level of customer service to patients and families.
Requirements
- High school graduate or GED required.
- Three to four years of work experience in insurance authorization or benefits verification, revenue cycle functions, hospital or physician offices, or related areas required.
- CRCS or equivalent certification for Access Professionals required within 18 months of hire.
- Strong organizational skills and ability to prioritize tasks.
- Excellent verbal and written communication skills.
- Strong interpersonal skills and ability to build rapport with a wide variety of individuals.
- Advanced working knowledge of code sets.
- Basic understanding of diagnostic testing and procedure codes, including CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS coding.
- Attention to detail and ability to multitask.
- Advanced knowledge of Microsoft Office, Word, and Excel.
- Proficient understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including medical necessity requirements for pharmaceuticals and recurring services.
Nice To Haves
- Work experience in healthcare or business.
- Bachelor’s degree.
- CPC, LPN, Pharmacology License, other medical degree, or equivalent.
- Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status.
Responsibilities
- Verify insurance and benefit information for transplant, surgical, chemotherapy, and radiation therapy patients.
- Understand insurance carrier options and verify eligibility according to departmental procedures.
- Obtain prior authorizations from third-party payers in accordance with payer requirements.
- Use necessary Epic applications from booking to obtain procedure codes as needed.
- Communicate professionally with patients, coworkers, and payer representatives.
- Contact patients as needed to gather demographic and insurance information, and update patient information in the EMR as necessary.
- Maintain knowledge of payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including medical necessity requirements for pharmaceuticals and recurring services.
- Perform other duties assigned by the Supervisor to support revenue cycle operations.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
