Financial Clearance Specialist

7 days ago


West Bridgewater, United States Brockton Hospital Full time

Signature Healthcare is Southeastern Massachusetts premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.

Position Summary:

Financial Clearance Specialist ensures all necessary information is proactively obtained and verified for proper financial reimbursement of services provided while maintaining a positive patient experience.

Location: 750 W. Center Street, West Bridgewater, MA

Department: Financial Clearance Specialist

This is a full-time 40 hour/ week position

Responsibilities:

+ Accesses work queues and reports and reviews patient accounts to determine 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. This includes personal/family relations, workers compensation insurance, third parties, behavioral health or others as required.

+ 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 visit.

+ Collects and validates order-related information including office visit, radiology and surgical orders.

+ Follows up with ordering provider to verify CPT codes.

+ Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices.

+ Enters and links referrals and/or authorizations in system.

+ Processes referrals when necessary, assuring proper tracking and redirection when appropriate.

+ Using system activities and functions, identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for 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.

+ 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 payers requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.

+ Communicates with patients and discusses their financial clearance status when necessary.

Education/Experience/Licenses/Technical/Other:

+ Education: High school graduate or equivalent

+ Experience:At least two years prior experience in a health care setting requiring knowledge of insurance coverage, reimbursement, and/or medical terminology and coding. Experience providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data.

+ Certification/Licensure:

+ Software/Hardware: Meditech experience preferred.

+ Other:



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