Financial Clearance Associate - Full Time, Evenings

About the role

We have an exciting opportunity to join our team as a Financial Clearance Associate - Full Time, Evenings - FIN-Financial Counsel - 2:00PM - 10:00PM Monday - Friday. In this role, the successful candidate will, under the general direction of the RCO Director and the assigned RCO Associate Director/Sr Manager/Manager/Supervisor, perform accurate and timely insurance clearance functions pre and post service to ensure maximum hospital reimbursement and mitigate insurance denials.

Responsibilities

• Verify insurance eligibility and determine patients’ insurance coverage and insurance authorization requirements.
• Obtain and document pre-authorizations and pre-certifications.
• Verify coverage levels.
• Utilize the Epic Estimate tool to calculate patients’ estimated hospital financial responsibility and ensure out-of-pocket amounts are communicated to the patient pre-service.
• Work cases timely and efficiently from the Epic Work Queues/DAR as assigned.
• Collect pre-service time of payments.
• Provide exceptional customer service to both internal and external stakeholders and facilitate RCO and patient financial needs.
• Perform insurance benefits verification to confirm eligibility for scheduled or prospective services.
• Review for appropriate coordination of benefits and identify discrepancies prior to clearance.
• Determine insurance authorization requirements for services scheduled or received.
• Ensure all scheduled services are authorized and appropriate notification and/or referral is obtained prior to the date of service to ensure payment for services.
• Ensure clear and timely documentation of all insurance clearance activities and outcomes, including authorization information in Epic.
• Perform all required follow-up to secure authorization pre-service, including follow-up with providers’ offices, scheduling departments and insurance companies.
• Perform medical necessity review for applicable services to ensure diagnosis is covered under insurance carrier clinical bulletin policy for outpatient appointments as scheduled.
• Determine patients’ benefit level based on in-network or out-of-network benefits.
• Identify non-par plan status and follow appropriate out-of-network workflow based on service and payor type.
• Calculate and communicate patients’ estimated out-of-pocket hospital financial responsibility pre-service for scheduled or prospective services utilizing the Epic Estimator tool or International Calculator.
• Understand performance measures and be accountable for meeting monthly target goals as determined based on service and payer.
• Exercise skill in prioritizing assignments in order to complete work in a timely manner when there are changes in workload, assignments, and pressures of deadlines, competitive requirements and/or a heavy workload.
• Demonstrate optimal customer service skills when interfacing with patients, patients’ families, physicians, physician office staff, and hospital colleagues.
• Demonstrate excellent communication skills; use appropriate vocabulary and grammar when obtaining and conveying information to physicians, nurses and staff at various levels; in person, over the phone, in writing and in electronically sent messages.
• Work collaboratively with and act as a liaison with a variety of internal departments within NYULH, external business partners, external departments, and NYULH’s contracted payers.
• Work independently, take initiative, and escalate to leadership appropriately.
• Answer and redirect phone calls as needed and respond to emails timely.
• Adhere to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required trainings, and other Hospital mandated activities.

Requirements

• High School Diploma and 1-year experience in patient accounts or related field or an equivalent combination of education and experience.
• Strong knowledge of front-end hospital, medical office, patient access, revenue cycle and/or practice operations.
• Knowledge of medical and insurance terminology.
• Knowledge of insurance benefit verification tools including payor portals, RTE, etc.
• Ability to perform with accuracy and attention to detail for meeting payer-imposed deadlines on a daily basis.
• Ability to compose and edit logical, detailed, comprehensive and grammatically correct correspondence.
• Ability to communicate effectively with a wide variety of personnel including patients, families, physicians and staff.
• Experience and competency with varied computer hardware and software, including registration and billing systems, word processing, spreadsheet, database, scheduling, communications.
• Ability to handle matters of highly confidential and sensitive nature.
• Ability to recognize and identify problems, recognize implications and propose alternative solutions.
• Skill in prioritizing assignments to complete work in a timely manner.
• Skill in working independently and in following through on assignments with minimal direction.

Preferred Qualifications

• Associates degree plus 2–3 years of experience in hospital admissions, patient accounts or medical records or in related field.
• Epic experience.

Pay

The salary range for the role is $57,817.50 – $57,817.50 annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.