Financial Clearance Specialist

City of Hope•Irwindale, CA

2d•Onsite

About The Position

This role works under the general direction of a supervisor or manager, responsible for performing pre-registration functions and obtaining authorizations from various insurance carriers. This role requires a high level of independent judgement in order to successfully coordinate and obtain authorization requests for complex managed care patients in a timely and efficient manner. This individual is expected to utilize telecommunications and computer information systems to pre-register patients, verify information and insurance, and obtain authorizations. The Financial Clearance Specialist is best defined as a highly independent and flexible resource that focuses on system-specific service lines that are in alignment with the patient experience initiative. Furthermore, this role must multi-task between different patient care areas to ensure an extraordinary patient experience and that quality standards are met. Additional duties include, but are not limited to physician and patient communication serving as an information resource.

Requirements

School Diploma or equivalent GED.
Three years related healthcare pre-registration/referral experience required.
Medical terminology and electronic medical record experience required.

Nice To Haves

At least two years front desk oncology practice experience registering patients and scheduling appointments.
EPIC EMR experience.

Responsibilities

Identifies insurance companies requiring prior authorization for services and obtains authorization.
Coordinates authorizations for procedures and testing requested by providers for their managed care patient.
Reviews charts on outpatients and reports to third party payors.
Retrieves chemo/surgery orders from chart, and requesting authorization through the insurance companies.
Prepares all forms required by third party payor for treatment authorization requests.
Work on all pending utilization review patients, and achieve authorization for the following day.
Getting emergent authorizations from walk-in patients.
Verifying with the insurance companies and documents what needs to be pre-certified.
Educates patient of their insurance policy.
Composes letters and memoranda from physician dictation, or verbal direction for submission to insurance companies to obtain authorization or appeal denials.
Maintains current records on managed care patients.
Keeps Case Managers updated on all BMO and BMT patients.
Performs pre-registration functions prior to the patient appointment (including, but not limited to: obtains and/or verifies demographic, clinical, financial, insurance information, service eligibility, consent forms, and patient/guarantor information for pre-registered accounts).
Contacts patients, payers, or other departments to confirm and verify insurance and demographic information.
Refers patients to financial counselors to resolve insurance or payments issues.
Identifies and resolves issues by working with patients, payors, and/or other CoH departments and personnel in a single interaction with the patient.
Identifies patients with “share of cost” or co-payments by performing pricing estimations, and notifies patients of their expected patient liability and financial responsibility.
Collects patient/guarantor liabilities and refers patients who are uninsured/underinsured to Financial Counselor for charity, financial assistance or governmental program screening and application processes.
Notifies CoH contracting department of patients with a non-contracted insurance to prepare a Letter of Agreement (LOA) should patient to pursue services at COH and informs patient of approval status.
Performs activities required to financial clearance for all patient types.
Frequent communications will occur with patients/family members/guarantors, physicians/office staff, medical center and payors.