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Revenue Cycle Specialist

2 months ago

West Bridgewater, Massachusetts, United States Brockton Hospital Full time
Job Summary

Brockton Hospital is seeking a skilled Financial Clearance Specialist to join our team. As a Financial Clearance Specialist, you will play a critical role in ensuring the financial clearance of patient services, maintaining a positive patient experience, and ensuring proper financial reimbursement.

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
  • Verify guarantor type and information
  • Create and verify all possible coverages
  • Validate coverages assigned to appropriate visits
  • Collect and validate order-related information
  • Follow up with ordering providers to verify CPT codes
  • Verify Primary Care Physician (PCP) information and ensure appropriate PCP referrals
  • Process referrals and track and redirect as necessary
  • Identify non-covered services and prepare 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 representatives
  • 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