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Oncology Financial Clearance Specialist PRN

2 months ago

Tallahassee, United States AdventHealth Full time
Comprehensive Benefits for You and Your Family:

• Benefits from Day One
• Paid Days Off from Day One
• Student Loan Repayment Program
• Career Development Opportunities
• Whole Person Wellbeing Resources
• Mental Health Support Services
• Pet Insurance and Debt-free Education options (Certifications and Degrees without out-of-pocket tuition costs)

Our Commitment to You:
Joining AdventHealth means becoming part of a larger mission. It’s about being part of a community that values the holistic nature of each individual and strives to uplift others in body, mind, and spirit. At AdventHealth, you will have the opportunity to thrive in your career while also growing spiritually, all while contributing to the Healing Ministry of Christ. You will be appreciated for your unique experiences and contributions to our purpose-driven team, understanding that together we achieve more.

Position Schedule:
PRN
Shift: Flexible Schedule

Role Overview:
This position is responsible for ensuring that patients are financially cleared for all appointments. Duties include performing eligibility verification, obtaining pre-certifications and/or authorizations, correcting registration errors, and executing additional responsibilities as needed.

Maintain effective communication with clinical partners to ensure seamless interaction between clinical, ancillary, and patient access departments.

Actively engage in providing exceptional service to both internal and external clients, taking responsibility for fostering respectful relationships.


Value You Bring to the Team:


• Proactively contact insurance providers via phone, fax, online portals, and other resources to verify insurance eligibility and benefits, determining coverage extent within established timeframes before scheduled appointments and during or after care for unscheduled patients.


• Meet departmental standards for obtaining pre-authorizations from third-party payers according to their requirements and within set timeframes.

• Accurately input required authorization data into AdventHealth systems, including authorization duration, total visits, and/or medication units.

• Collaborate closely with clinical partners and physician offices to resolve pre-authorization issues.

• Conduct diligent follow-ups on missing or incomplete pre-authorizations with third-party payers to minimize authorization-related denials through various communication methods, updating documentation as necessary.

• Ensure patient accounts are assigned to the correct payor plans.

• Keep all financial assessments, eligibility, and benefits current and thorough to support post-care financial needs.

• Exercise caution to ensure that obtained benefits, authorizations, and pre-certifications are accurate to avoid rejections or denials.

Stay informed about online eligibility pre-certification tools available.

• Document all interactions with patients and insurance representatives, including payer decisions, collection attempts, and payment arrangements.

• Coordinate with case management staff as needed (e.g., when pre-authorization cannot be secured for an inpatient stay).

• Comply with HIPAA regulations by verifying caller authorization levels before sharing account information.

• Create accurate estimates to maximize upfront cash collections and add necessary documentation for collections.

• Calculate patients' co-pays, deductibles, and co-insurance.

• Provide personalized estimates of patient financial responsibility based on their insurance coverage or eligibility for government programs prior to service for both inpatient and outpatient services.


Required Knowledge and Skills:
• Ability to handle confidential personnel and patient-related issues with discretion.

• Adaptability to the dynamic needs of the hospital environment.

• Self-motivated, capable of multitasking, prioritizing duties, and attentive to detail while being responsive to departmental needs.

• Proficient in Microsoft Office Suite, including Outlook, Word, and Excel.


• Strong basic math skills and the ability to communicate professionally and effectively in English, both verbally and in writing.


Preferred Knowledge and Skills:
• Bilingual (English required, Spanish preferred) in both written and verbal communication.

• Familiarity with Electronic Health Records (EHR).

• Experience in obtaining insurance authorizations.

• Understanding of medical terminology.

Education and Experience Requirements:


• One (1) year of experience in Patient Financial Services, Patient Access, Customer Service, or a related field (registration, finance, collections, customer service, medical office, or contract management).


Preferred Education and Experience:
• Associate degree or higher-level education or completed coursework.


• Two (2) years of experience in Oncology-related business operations, including specialty pharmacy, insurance verification, payer reimbursement guidelines, and/or authorization submission.

Familiarity with medical terminology and concepts, along with working knowledge of third-party insurance administrators' authorization and clinical care processes.

This facility is an equal opportunity employer and adheres to federal, state, and local anti-discrimination laws, regulations, and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience, and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category:
Radiology/Imaging

Organization:
AdventHealth Celebration

Schedule:
Per Diem

Shift: - Day

Req ID:


We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age, or disability/handicap concerning recruitment, selection, placement, promotion, wages, benefits, and other terms and conditions of employment.