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Financial Clearance Specialist

2 months ago

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

Brockton Hospital is seeking a highly skilled Financial Clearance Specialist to join our team. As a Financial Clearance Specialist, you will play a critical role in ensuring that 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 of specific patient services.
  • Take action on services without financial clearance.
  • Verify demographic and patient contact information with the patient or patient representative.
  • Verify guarantor type and information and assign it to the account correctly.
  • Create and verify all possible coverage's through electronic or manual methods and resolve discrepancies.
  • Validate coverage's assigned to appropriate visit.
  • Collect and validate order-related information including office visit, radiology and surgical orders.
  • Follow up with ordering provider to verify CPT codes.
  • Verify Primary Care Physician (PCP) information and ensure appropriate PCP referrals are in place for the provider and service.
  • Enter and link referrals and/or authorizations in system.
  • Process referrals when necessary, assuring proper tracking and redirection when appropriate.
  • Identify non-covered services and prepare proper Advance Notice Beneficiary (ABN) or waiver for registration team.
  • Analyze clinical documentation in support of ordered procedure(s) and submit precertification requests through various insurance fax lines, phone systems and web portals.
  • Follow up on pending accounts and involve ordering provider offices as needed to obtain approvals.
  • Escalate challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery.
  • Verify covered benefits, including remaining hospital days, carve out coverage's and benefit limits of visit and/or timeframe.
  • Contact patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies.
  • Communicate with patients and discuss their financial clearance status when 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, while processing and verifying electronic demographic, financial or other business-related information and data.
Preferred Qualifications
  • Meditech experience preferred.
Working at Brockton Hospital

Brockton Hospital is a leading healthcare provider in the region, dedicated to delivering personalized healthcare services in a welcoming and medically advanced environment. Our focus on quality care, matched with our commitment to serving every individual, fosters an inclusive and supportive environment for our employees to grow and flourish in their careers. We offer a comprehensive benefits package, including medical, dental, and vision insurance, life and disability insurance, retirement savings plan, employee assistance program, voluntary benefits, tuition reimbursement, PTO, and paid holidays.