Financial Clearance Specialist

Logan Health•Kalispell, MT

5d•Onsite

About The Position

At Logan Health, we're more than just a healthcare provider – we’re a community. Nestled in the heart of Montana, we are committed to delivering exceptional care to our patients while fostering a supportive and collaborative work environment for our team. As a member of Logan Health, you'll be part of a dynamic team that values compassion, innovation, and excellence. We offer opportunities for growth, comprehensive benefits, and a chance to make a meaningful impact in the lives of those we serve. Come join us and experience the Logan Health difference, where your passion meets purpose in a place you’ll be proud to call home. Our Mission: Quality, compassionate care for all. Our Vision: Reimagine health care through connection, service and innovation. Our Core Values: Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence. Join the Financial Clearance team! Location: Logan Health Hematology & Oncology – Kalispell, MT Schedule: Day Shift – 8 Hours | Full Time – 40 Hours Are you detail-oriented, great with numbers, and passionate about helping people navigate the world of healthcare insurance? As a Financial Clearance Specialist at Logan Health, you’ll play a key role in ensuring our patients have a smooth experience by verifying insurance, estimating patient costs, and supporting our clinic teams in providing exceptional care.

Requirements

2+ years of experience in registration, financial clearance, or patient financial services, with strong healthcare insurance knowledge.
Excellent understanding of insurance coverage, benefit verification, and reimbursement rules.
Strong math and analytical skills.
Proficiency with Microsoft Office Suite and the ability to learn new software.
Highly organized, detail-oriented, and able to set priorities.
Excellent verbal and written communication skills; comfortable interacting with a variety of audiences.
Strong interpersonal skills with professionalism, tact, and diplomacy.
Critical thinker; works well independently and as part of a team.
Commitment to confidentiality and team collaboration.
Minimum of two (2) years’ work experience in registration, financial clearance or patient financial services with strong working knowledge of healthcare insurance and benefit programs required.
Excellent knowledge of applicable rules and guidelines governing traditional insurance coverage and reimbursement required.
Strong math and analytic skills required.
Possess and maintain computer skills to include working knowledge of Microsoft Office Suite required.
Possess ability to learn other software as needed.
Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
Commitment to working in a team environment and maintaining confidentiality as needed.
Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.

Nice To Haves

Associate’s or Bachelor’s degree.
Experience with managed care coverage, reimbursement, medical terminology, and medical coding.
Background in medical office or hospital setting.
Associate’s or Bachelor’s degree preferred.
Strong working knowledge of applicable rules, regulations and guidelines governing managed care coverage and reimbursement preferred.
Background knowledge and understanding in medical terminology and medical coding preferred.

Responsibilities

Verify insurance eligibility, benefits, and patient liability to prevent denials or penalties.
Accurately document insurance and payment information to optimize reimbursement and avoid write-offs.
Maintain up-to-date knowledge of insurance plans, contract requirements, and best practices for insurance verification.
Confirm and secure benefits coverage with insurance companies and employers; ensure demographic data is correct.
Cross-reference Medicare accounts and coordinate benefit statuses as needed.
Determine and process pre-certification or referral requirements per protocol.
Communicate with providers regarding out-of-network barriers and document accordingly.
Estimate and collect patient liability prior to service, following cash management policies.
Maximize collection of co-pays and other balances per department protocol.
Review and resolve accounts on hold to ensure timely billing.
Partner with the Authorization team to obtain payer authorizations and referrals.
Ensure compliance with HIPAA and all insurance process regulations.
Continue developing your skills to keep up with changes in insurance and reimbursement rules.
Maintain regular and consistent attendance as scheduled by department leadership.
Obtains reports needed to begin insurance verification processes that are outside of Meditech Worklists.
Confirms eligibility and secures full benefits coverage information with insurance companies and employers.
Confirms demographic information is correct and assures coordination of benefits (COBs) and insurance plan codes are accurate.
Verifies Medicare accounts, cross-referencing traditional Medicare and other providers as required.
Determines number of prior Medicare days and reviews system to determine appropriate status.
Notifies the physician office if the admit status needs to be changed.
Verifies insurance coverage for inpatient and outpatient accounts per department protocol.
Determines pre-certification or referral requirements per department protocol.
Communicates with provider regarding out of network barriers and documents accordingly.
Calculates, communicates, and collects the patient liability prior to service.
Conducts all transactions consistent with cash management policies and procedures.
Maximizes collection of money by estimating patient liabilities and requesting collection of co-payments and other personal balances per department protocol.
Assures accounts are distinguished and handled appropriately per department protocol.
Furnishes needed documentation to the appropriate stakeholders in order to obtain approval.
Reviews, follows up, and rectifies accounts held due to claim edits to ensure timely submission for billing.
Partners with Authorization team members to obtain authorization and referrals from payer.
Completes documentation as required for coordination of care and patient account management.
Maintains compliance with HIPAA regulations as it pertains to the insurance process.
Develops and maintains knowledge and skills to identify insurance plans correctly in the system, understands contract requirements and maintains accurate insurance information.
Maintains professional development to remain up-to-date on insurance rules, regulations and changes within the industry.