Financial Clearance Specialist, PRN

1. General Summary:

Under limited supervision, responsible for coordinating the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including, validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration.  Responsible for triaging complex financial clearance work.

1. Principal Responsibilities and Tasks
    

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Coordinates administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals.

1. Manages service line, and/or complex multi-payer insurance verification and benefit eligibility validation and prior authorizations, including obtaining and completing documentation for pre-certification and referrals/authorizations.

1. Performs root cause analysis on no authorization denials.

1. Cross trains and provides guidance to team of financial clearance specialists in day to day operations

1. Maintains regular communication and follow-up with patients and families to keep them informed of clearance and self-pay matters.

1. Maintains regular communication and follow-up with program and department contacts regarding pending insurance, coverage, and other payment-related matters.

1. Develops denial mitigation strategies with staff in registration, patient financial services, and clinical areas, as applicable.

1. Must be willing to travel between facilities as needed (applies to specific UMMS Facilities).

1. Performs other duties as assigned.

1. Education and Experience

1. Requires minimum of Associates Degree. Work experience may substitute degree (i.e. 2 years of experience for 1 year of education).

1. Minimum 4 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.

1. Experience in healthcare registration, insurance referral, authorization processes, patient access and hospital billing operations of EPIC system required.

Knowledge, Skills and Abilities

1. Intermediate proficiency in Microsoft Office.

1. Excellent verbal, communication, interviewing, and interpersonal skills to interact with peers, superiors, patients, member of healthcare team and external agencies.

1. Ability to understand, interpret, evaluate, and resolve complex customer service issues.

1. Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.

1. Knowledgeable of financial clearance functions, can problem solve functional level issues, and is able to provide input from an operational perspective for decision-making.

1. Advanced analytical skills to resolve complex problems and provide patient and referring physicians with information and assistance with financial clearance issues.

1. Effectively maintains leadership in group environment and promotes teamwork.

1. Must be able to work concurrently on a variety of tasks/projects.

1. Ability to meet customer service, productivity and quality standards.

1.  Must maintain confidential information.

1. Advanced knowledge of healthcare revenue cycle, reimbursement, medical and insurance terminology.

1. Advanced knowledge and demonstrated proficiency in government and non-governmental regulations, payer billing and regulations, and manage care plans.

1. Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes required.