Lead Financial Clearance Spec-REMOTE

UMass Memorial Health Care-posted 23 days ago
$22 - $37/Yr
Full-time • Mid Level
Remote • Worcester, MA
5,001-10,000 employees
Hospitals
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Under the general direction of the Financial Clearance Supervisor, Manager and/or Director, provides functional oversight to an assigned group of Financial Clearance Specialists to generate required insurance referrals and/or authorizations for urgent/emergent inpatient visits, scheduled outpatient procedures and testing prior to services being rendered and/or the release of a claim to the insurance company. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

  • Distributes and monitors the flow of work for an assigned group of employees. Provides training and technical assistance to employees within the assigned work area
  • Serves as a lead in implementing new or revised systems and procedures. Performs basic trouble -shooting and provides feedback on process improvements.
  • Performs a variety of complex duties utilizing advanced insurance and payor knowledge. This includes the financial clearance of patients for all inpatient admissions, surgical procedures, ambulatory/outpatient visits, tests and ancillary services.
  • Works the referrals work queue and verifies that all authorizations and pre-certifications are in place prior to services being rendered and align with provided CPT and ICD-10 codes. Investigates all elective same day surgeries and inpatient admissions for referral and/or authorization requirements.
  • Verifies insurance eligibility utilizing available technologies, payor websites, or by phone contact with third party payors.
  • Verifies patient insurance coverages using real time eligibility or batch processing as appropriate.
  • Verifies that the correct insurance company name, address, plan, policy number and filing order are entered in the Epic system.
  • Work patient and payor work queues so that patient accounts are complete prior to services being rendered.
  • Complies with referral management regulations established for primary care providers.
  • Communicates with insurance companies regarding all urgent/emergent surgeries/admissions following payor guidelines.
  • Financial clearance may consist of updates and corrections to patient demographic and insurance information, verifying benefit information and obtaining prior insurance referrals and authorizations.
  • May collect patient liabilities on or prior to the date of service as appropriate.
  • Distributes and monitors the flow of work for an assigned group of employees. Provides training and technical assistance to employees within the assigned work area. Assists supervisor in assuring that assigned employees are provided with appropriate resources, materials, and methods. Provides recommendations to manager or supervisor for the most efficient utilization of assigned personnel. Relays work instruction from the supervisor. Provides direction, guidance and leadership in the absence of the supervisor.
  • Complies with established departmental policies, procedures and objectives.
  • Attends variety of meetings, conferences, seminars as required or directed.
  • Demonstrates use of Quality Improvement in daily operations.
  • Complies with all health and safety regulations and requirements.
  • Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
  • Maintains, regular, reliable, and predictable attendance.
  • Performs other similar and related duties as required or directed.
  • High School Diploma.
  • Minimum of 3 years insurance verification and/or authorization experience.
  • Minimum 1-year experience as a Financial Clearance Rep in good standing. (no documented warnings within 6 months).
  • English speaking, reading and writing skills.
  • Strong oral and written communication and customer service skills.
  • Ability to use specialized applications software and computers systems for patient registration and scheduling.
  • Demonstrated knowledge of medical terminology.
  • Associate Degree in Business or Healthcare related field.
  • Bilingual.
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