Financial Clearance Specialist

South Shore Health•Norwell, MA

21h•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 involves ensuring accounts are processed with minimal denials, determining and arranging for co-pay collection, and complying with all regulatory agencies. The specialist must stay current with internal and external policies affecting reimbursement, manage appeals for denials, provide self-pay estimates, and document all actions. Collaboration with case management and managing level of care changes are also key. The position requires embracing technological solutions, including using department computer programs like Meditech, PICIS, Passport, and web-based programs, as well as managing API systems and understanding computer downtime procedures. A strong commitment to safety awareness, adherence to patient identification policies, universal precautions, and understanding emergency preparedness roles are also essential. The specialist is expected to participate in continued learning and utilize new technology. South Shore Health is a not-for-profit, charitable health system offering primary and specialty care, hospital care, home health and community care, emergency and urgent care, and preventative and wellness services, and is the largest independent health system in Southeastern Massachusetts.

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
Insures 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
Embraces technological solutions to work processes and practices.
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
Understand process for computer downtime
Understand and promotes credit and collection policy
Able to assign and trascribe ICD-9 and CPT codes
Manage and utilize insurance web sites to ensure appropriate notification and referrals are done
Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment.
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 possess 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.