Financial Clearance Specialist

Montefiore Nyack Hospital•New City, NY

13d•$23 - $24

About The Position

Under general supervision and in accordance with established policies and procedures, the Financial Clearance Specialist coordinates insurance clearance for scheduled and unscheduled appointments. This includes services such as diagnostic testing, surgery, pathology, laboratory work, and clinical trial research. The specialist verifies eligibility, benefits, referral and authorization requirements; obtains referrals and authorizations; researches scheduled services; identifies appropriate procedure codes; and completes financial work-ups and collections by phone or before or on the date of service. The role serves as a liaison among patients, referring physicians, and insurance plans to ensure services are financially cleared several days before service when possible. The specialist also follows up on self-pay accounts, assists walk-in patients, and explains payment options—including Medicaid, charity care, and payment plans—to uninsured patients. Additional duties under general supervision include registration, verification, claim submission, follow-up, cash application, account collection, appropriate referrals, and helping patients select or process financial assistance options through Financial Counseling.

Requirements

High school education required.
Medical billing experience required.
Personal computer knowledge required.
Ability to perform effectively despite sudden deadlines and changing priorities.
Sound judgment and problem-solving ability, with a service-excellence focus.
Excellent comprehension skills.
Ability to use departmental policies, procedures, and protocols to evaluate options and determine the best alternative for patients in matters related to Financial Clearance.
Ability to read and understand requisitions, referrals, insurance forms, patient-related data, other forms, insurance screens, departmental protocols, and written directions.
Ability to use protocol information to fulfill duties effectively and responsibly.
Ability to complete simple reports.
Excellent verbal and written communication skills.
NYSOH Healthcare Exchange Assistor certification required within the first year of employment.

Nice To Haves

Associate degree preferred.
Bilingual in Spanish preferred.
NYSOH Healthcare Exchange Assistor certification preferred.

Responsibilities

Collect financial and demographic information; interview, instruct, and assist patients with Medicaid applications.
Monitor self-pay patients, inquire about coverage, offer options, and assist with payment.
Work with Case Management to expedite insurance-related placement issues and reduce length of stay.
Respond to billing inquiries and resolve problems for walk-in patients and guarantors.
Follow up on pending Medicaid decisions for timely account reclassification and rebilling.
Maintain and reconcile accounts outsourced to agencies for presumptive Medicaid.
Perform audits to support ongoing registration quality.
Contact insurance carriers to confirm authorizations and benefits before elective services or within 24 hours of urgent or emergency admissions.
Minimize accounts not selected for billing, recognize deficiencies, and address their impact on the revenue cycle.
Prepare accurate collection notes so users can access pertinent financial information promptly.
Coordinate insurance clearance for scheduled and unscheduled appointments, including verifying eligibility, benefits, referral requirements, and authorizations.
Research appointments and scheduled services and identify appropriate procedure codes.
Complete financial work-ups and collect or request payment by phone or before or on the date of service.
Serve as a liaison among patients, referring physicians, and insurance plans to support timely financial clearance.
Assist walk-in patients and uninsured patients with payment options, including Medicaid, charity care, and payment plans.
Complete registration, verification, claim submission, follow-up, cash application, account collection, and appropriate referrals.
Provide positive customer service, communicate with people of different cultures, values, and beliefs, acknowledge concerns, take corrective action, and escort customers when necessary.
Participate in department- and hospital-wide process or outcome improvement activities and annual competency assessment; maintain self-development and comply with licensure or certification requirements.
Use equipment and supplies in a fiscally prudent manner and follow the charge process for supplies and equipment.
Complete projects and assignments within established time frames and expectations.