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2 months ago

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The Financial Clearance Coordinator is a member of the Patient Access team and will report to the Manager of Financial Clearance. Coordinators will provide administrative support and complete patient access workflows related to generating patient estimates for clinical services. The Financial Clearance Coordinator will work directly with physicians, payers, and patients to ensure full detailed audits of patient's data capture and financial responsibilities prior to the provision of care. Works directly with Revenue Cycle Analytics, Business Operations, Managed Care, and other departments on identified process improvements. In addition, complete monthly audits and presentations to provide timely feedback to servicing area leadership to drive desired outcomes. Financial Clearance Coordinators will provide training and education to managers and staff to obtain sustainable improvements in areas of opportunity.

Qualifications:
Minimum Education
Bachelor's Degree Work requires analytical, communication and organizational skills generally acquired through completion of a bachelor's degree program. Degree in Research Administration, Business Administration, Finance, Hospital Management, or Healthcare Administration preferred. (Required)

Minimum Work Experience
4 years Healthcare experience in Business Operations, Patient Access and Revenue Cycle. Prior auditing experience and root cause analysis. Proficient in Microsoft office products. (Required)
3 years Data Analytics (Required)
3 years Experience in program administration involving academic, medical or research activities to acquire skills necessary to plan, coordinate and implement a variety of program activities (Required)

Required Skills/Knowledge
Superior customer service skills and professional etiquette
Strong written, verbal, interpersonal, and telephone skills
Attention to detail and ability to multi-task in complex situations
Knowledge of and compliance with confidentiality guidelines and CNMC policies and procedures
Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers
Computer Skills - Excel, Microsoft Word, Access, & PowerPoint
Previous experience with Cerner, Experian, or other related software programs and EMRs preferred
Successful completion all Patient Access training assessments required and meet minimum typing requirements

Functional Accountabilities
Financial Clearance

  • Generate patient estimates for assigned clinical services. Inform families and patients of estimated cost of service(s) via inbound and outbound calls in a timely and professional manner.
  • Verify insurance eligibility and benefits by utilizing integrated real-time eligibility tool, payer websites, and telephone calls to payers; document payer verification responses in designated fields within the registration pathway; compare the primary care physician (PCP) information indicated by the insurance verification response to the location of the primary care office visit, if applicable; contact the patient/family and provide guidance for resolution of PCP discrepancies or mismatches.
  • Validate authorization status, if applicable, and communicate with ordering physicians' offices to obtain authorization information; document authorization status in designated field within the registration pathway.
  • Identify patients requiring payment assistance options and facilitate communication between patients and CNMC Financial Information Center (FIC).
  • Complete data deep dives and identify trends, root causes, corrective actions and present outcomes to leadership via monthly meeting, presentations and reports.
  • Audit performance by registration staff across the enterprise and communicate findings to the appropriate department leaders; collaborate with individual departments - Compliance Department, Patient Financial Services, Case Management, and Centers of Excellence to reduce first pass denials.
  • Audit price estimations to ensure the control and validity process.
  • Review all appealed cases based on estimates to identify trends, root causes, corrective actions and appeal options. Based on outcomes complete recovery with guarantors and business operations to increase the organizations financial strength.
  • Run and identify areas of review and complete monthly audits and track volumes and outcomes for all service areas. Provide findings to leadership.
  • Review eligibility system usage compliance and communicate outcomes accordingly.
Staff Developments and Special Projects
  • Based on outcomes and trends provide training and site visit to aid to staff education and productivity.
  • Develop training tools and materials accordingly and monitor their use and compliance.
  • Build standard processes and to increase TOS collections and decrease first pass denials.
  • Participate and take lead on special projects that impact revenue cycle.
  • Research revenue cycle related outcomes to support business decisions.
  • May perform other duties as assigned.
Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
  • Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication
  • Demonstrate collaborative and respectful behavior
  • Partner with all team members to achieve goals
  • Receptive to others' ideas and opinions
Performance Improvement/Problem-solving
  • Contribute to a positive work environment
  • Demonstrate flexibility and willingness to change
  • Identify opportunities to improve clinical and administrative processes
  • Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
  • Use resources efficiently
  • Search for less costly ways of doing things
Safety
  • Speak up when team members appear to exhibit unsafe behavior or performance
  • Continuously validate and verify information needed for decision making or documentation
  • Stop in the face of uncertainty and takes time to resolve the situation
  • Demonstrate accurate, clear and timely verbal and written communication
  • Actively promote safety for patients, families, visitors and co-workers
  • Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance