Financial Clearance Specialist

Beth Israel Lahey Health•Beverly, MA

2d•$21 - $28•Onsite

About The Position

This position completes all financial clearance activities for services rendered in outpatient departments. Monitors outcomes to ensure medical necessity and authorization requirements are met. Provides feedback to departments on medical necessity and authorization processes.

Requirements

High School diploma or GED required.
1-3 years related work experience required.
Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) coding and International Classification of Diseases (ICD-9, ICD-10).
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Nice To Haves

Associate's degree preferred.
3+ years of related experience; two or more years of prior work experience in Financial Clearance activities.
Knowledge of payer policies for medical necessity/authorization requirements.
Prior experience working with Craneware software.

Responsibilities

Verifies patient's insurance eligibility for visit, using various online tools and by contacting the payer directly.
Identifies payer medical necessity determination before services are rendered. Informs departments of failed instances. When circumstances dictate, requests additional information to re-run medical necessity check.
Determines authorization requirement and, when necessary, obtains authorization from payer by utilizing payer specific protocols. Requests and coordinates any additional information from departments when needed.
Identifies and escalates issues timely and appropriately for resolution and communicates and coordinates with revenue cycle peers, leadership and clinical stakeholders. Documents interim and final results in appropriate systems.
Completes assigned work queues and reports daily to achieve standards of productivity and quality. Assists with reviewing medical necessity and obtaining authorization for urgent or walk-in visits. Refers patients to financial counselors to resolve complex financial issues and/or inquiries.
Follows BIDMC policies, procedures and training materials to ensure compliance to federal, state, and contractual requirements.
Identifies trends and provides periodic reports to departments on operational, productivity, and quality metrics.
Performs other activities on an as-needed basis to support the department.