Financial Clearance Specialist

South Shore Health•Norwell, MA

17h•Onsite

About The Position

Under the direction of the Manager of Patient Access Services, the Financial Clearance Specialist is responsible for all pre-certification, eligibility, verification of benefits, and collection of eligible co-pays. This role ensures that accounts are processed accurately, complies with regulatory agencies, and stays current with internal and external policies affecting reimbursement. The specialist will also handle appeals for denials, provide estimates for self-pay and non-covered services, and document all actions clearly. Collaboration with case management and adherence to credit and collections policies are key aspects of this position. Additionally, the role involves managing level of care changes for proper reimbursement and embracing technological solutions to enhance work processes.

Requirements

Medical terminology.
Insurance Knowledge.
Computer skills.
Strong knowledge of third party insurance required.
Ability to follow through and troubleshoot.
Attention to detail.
Customer Service skills.
Organizational skills.
Ability to work well within a team.

Responsibilities

Responsible for registration, pre-certification, eligibility, verification of benefits and co-pay determination on all accounts.
Ensures that account is processed with less than 5 denials per year.
Determination of copay and notify patient and arrange for collection.
Complies with all regulatory agencies (newborn notification) 100% of the time.
Keeps current with all internal and external policies and procedures which may affect reimbursement.
Ability to write and follow up on appeals for denials.
Ability to give patients estimate for self-pay and non-covered services.
Document clearly on account all actions and transactions.
Able to collaborate with case management for patient care.
Able to defer elective cases based on credit and collections policy.
Manage level of care changes to ensure proper reimbursement.
Able to function using department computer programs (Meditech, PICIS, Passport and web based programs, and run reports).
Able to use and update PICIS, Tracker and Passport programs.
Manage own API (timecard) system.
Able to utilize the telephone system, including VERA.
Understands process for computer downtime.
Understands and promotes credit and collection policy.
Able to assign and transcribe ICD-9 and CPT codes.
Manage and utilize insurance web sites to ensure appropriate notification and referrals are done.
Adheres to patient identification policies/procedures.
Adheres to universal precautions and respiratory etiquette guidelines.
Understands individual role/responsibility during hospital codes (e.g. Code Green, Code red).
Do safety rounds.
NIMS 100 completed.
Understand role in department specific plan for emergency preparedness.
Able to identify correct subscriber.
Participates in continued learning and possesses a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.
Embraces technological advances that allow us to communicate information effectively and efficiently based on role.
Can register patients meeting the department standard of 98% accuracy rate.
Other duties as required.