Senior Financial Clearance Specialist

Beth Israel Lahey Health-posted 3 months ago
Full-time • Entry Level
Cambridge, MA
Hospitals
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When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Contribute to Beth Israel Lahey Health's (BILH) mission by ensuring that all information necessary for proper financial reimbursement for high-dollar patient care is analyzed and submitted to insurance companies for approval prior to the patient's date of service. Collaborate with insurance companies when necessary to proactively validate benefits, eligibility, and referral requirements. Communicate with patients to ensure they understand their payment obligations and steps necessary to meet these obligations while maintaining a positive patient experience.

  • Accesses work queues and reports and reviews patient accounts to determine the financial clearance status of specific patient services.
  • Takes action on those services without financial clearance.
  • Ensures demographic and patient contact information is complete and verified with the patient or patient representative.
  • Verifies the guarantor type and information and ensures it is assigned to the account correctly.
  • Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved.
  • Validates that coverages are assigned to appropriate visits.
  • Collects and validates visit-related registration information including MSPQ, occurrence codes, and attending and referring providers.
  • Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service.
  • Enters and links referrals in the system.
  • Processes referrals when necessary, assuring proper tracking and redirection when appropriate.
  • Understands each clinical department's referral certification protocols and ensures referrals are certified at the appropriate level.
  • Identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for the registration team.
  • Documents account for registrar action.
  • Analyzes clinical documentation in support of ordered procedure(s) and submits precertification requests through various insurance fax lines, phone systems, and web portals.
  • Follows up on pending accounts and involves ordering provider offices as needed to obtain approvals.
  • Escalates challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery.
  • Collaborates with clinical departments to facilitate scheduling of approved procedures and rescheduling of non-urgent non-certified cases.
  • Professionally communicates outcomes to patients when needed.
  • Escalates non-certified urgent cases to appropriate clinical departments and leadership for approval to proceed or reschedule.
  • Verifies covered benefits, including remaining hospital days, carve out coverages, and benefit limits of visit and/or timeframe.
  • Contacts patients, providers, and insurance companies to validate data, collect missing information, and resolve information discrepancies.
  • Understands clinical guidelines for payors requiring authorization to better build cases for authorization requests.
  • Communicates with patients and discusses their financial clearance status when necessary.
  • Explains the status of any services not financially cleared and advises patients of the proper resolution steps, including self-payment.
  • Directs patients to Lahey Financial Counselors when appropriate.
  • Works with the Financial Counselors, clinical departments, outside providers, third-party insurers, and any other individual or entity to assist in resolving patient financial clearance questions or problems.
  • Researches claim edits and payment denials related to financial clearance and works closely with the Lahey Patient Financial Services staff to resolve these denials.
  • Communicates resolution to patients.
  • High School Diploma or equivalent.
  • At least two years prior experience in a business/health care setting is required.
  • Knowledge of insurance coverage and/or reimbursement required.
  • Experience providing customer service, while processing and verifying electronic demographic, financial, or other business-related information and data.
  • Able to work successfully in a fast-paced, multi-task environment, where some independent decision-making is necessary.
  • Able to process electronic information and data accurately and efficiently.
  • Must be able to read, write, and communicate effectively in English with patients, visitors, and fellow members of the hospital.
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