Financial Clearance Specialist

3 days ago


West Bridgewater, Massachusetts, United States Signature Healthcare Full time

About Signature Healthcare

Signature Healthcare is a leading provider of quality medical services in Southeastern Massachusetts. Our team of medical professionals is dedicated to delivering personalized care to our patients.

Job Summary

We are seeking a Financial Clearance Specialist to join our team. This role is responsible for ensuring all necessary information is obtained and verified for proper financial reimbursement of services provided, while maintaining a positive patient experience.

Key Responsibilities

  • Access and review patient accounts to determine financial clearance status.
  • Take action on services without financial clearance.
  • Verify demographic and patient contact information.
  • Assign guarantor type and information correctly.
  • Create and verify coverage's through electronic or manual methods.
  • Validate coverage's assigned to appropriate visit.
  • Collect and validate order-related information.
  • Follow up with ordering provider to verify CPT codes.
  • Verify Primary Care Physician (PCP) information and ensure appropriate PCP referrals are in place.
  • Enter and link referrals and/or authorizations in system.
  • Process referrals when necessary.
  • Identify non-covered services and prepare proper Advance Notice Beneficiary (ABN) or waiver.
  • Analyze clinical documentation and submit precertification requests.
  • Follow up on pending accounts and involve ordering provider offices as needed.
  • Escalate challenging accounts to provider representative.
  • Verify covered benefits and communicate with patients and providers as necessary.

Requirements

  • High school graduate or equivalent.
  • At least two years prior experience in a healthcare setting requiring knowledge of insurance coverage, reimbursement, and/or medical terminology and coding.
  • Experience providing customer service and processing electronic demographic, financial, or other business-related information and data.


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