Financial Clearance Specialist

5 days ago

Stony Brook, United States Stony Brook University Hospital Full time

**Financial Clearance Specialist - Cancer Center**

**Position Summary**

The **Financial Clearance Specialist** is responsible for ensuring that payers are prepared to reimburse Stony Brook University Hospital Cancer Services for scheduled services in accordance with the payer-provider contracts. When physicians and clinicians make care decisions, the Financial Clearance Specialist is aware of how a patient's benefits fit into the care plan and keeps patients and physicians informed of such, as they seek to obtain authorizations from payers.

**Duties of a Financial Clearance Specialist** **may include the following but are not limited to**:

- Obtains the financial clearance of transplant, chemotherapy, immunotherapy, oral chemo, radiology, oncology-related procedures and other services in high-pressure situations as required.
- Must utilize an understanding of ICD-10, CPT, HCPCS/JCodes, and comprehension of chemotherapy, immunotherapy cycle length, dose and frequency.
- Maintain a proficient understanding of third-party payer regulations and guidelines for these particular service lines, including a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that oncology patients require.
- Performs insurance verification, and validation of medical necessity for certain services.
- Contacts insurance companies through online portal, phone, or fax to initiate authorization, obtain insurance benefits, eligibility, medical necessity, and/or authorization information.
- Maintains a close working relationship with clinical partners and/or ancillary departments to ensure continual open communication between clinical, ancillary and all Revenue Cycle departments.
- May contact physicians or their staff to facilitate the sending of clinical information in support of the authorization to the payor, as assigned.
- Researches additional or alternative resources for non-covered services to prevent payment denials.
- Responsible for communicating to service line clinical partners in situations where rescheduling is necessary due to lack of authorization and/or limited benefits.
- Confirm and document all financial clearance information in the patient’s EMR including, prior authorization verification number, effective start and end dates, and the number of units approved.
- Determine benefit and coverage levels and connects patients with Financial Navigators for resources as needed.
- Works closely with Patient Accounting, and other key stakeholders in the revenue cycle to ensure all pertinent patient and insurance information is on file for clinical submission and billing.

**Qualifications**

**Preferred**:Healthcare or insurance industry experience. Experience with Medicare, Social Security and/or Medicaid systems. Bilingual.
- ___________________________________________________________________
- Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
- This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
- This function/position maybe designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
- Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
- Complete electronic reference check with a minimum of three (3) professional references.
- Successfully complete a 4 panel drug screen*
- Meet Regulatory Requirements for pre employment screenings.
- Provide a copy of any required New York State license(s)/certificate(s).

**Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.**
- **The hiring department will be responsible for any fee incurred for examination**.
- __________________________________________________________________

Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.

**If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.**

**_ In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed_**_ _**_here_**_._**

**Visit our** **WHY WORK HERE** page to learn about the

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