Financial Clearance Specialist

Placement within the salary range is dependent on relevant work experience and internal equity. For positions represented by a labor union, placement is guided by the rules outlined in the collective bargaining agreement.

Pay

$21.29 - $27.67 (Hourly Rate)

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)
• $10,000 Student Loan Repayment ($5,000 part-time)
• $1,000 Professional Development per year ($500 part-time)
• $250 Wellbeing Fund per year ($125 for part-time)
• Matching 401(k)
• Excellent medical, dental and vision coverage
• Life insurance
• Annual Employee Salary Increase and Incentive Bonus
• Paid time off and Holiday pay

About the role

The Financial Clearance Specialist reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities

• Consistently practices Patients First philosophy and adheres to high standards of customer service, fostering a team atmosphere.
• Responds to questions and concerns, forwarding or directing extraordinary issues to the Team Lead or Operations Coordinator as necessary.
• Maintains patient confidentiality per HIPAA regulations.
• Provides exceptional customer service to establish a positive first impression of Northwestern Medicine, exceeding all consumer requests and escalating issues as needed.
• Correctly identifies and collects patient demographic information in accordance with organization standards.
• Responds to telephone inquiries and performs appropriate actions, documenting all actions in the appropriate software applications.
• Monitors admission/registration and scheduled surgeries flow of patient information through the revenue cycle.
• Serves as a resource to staff and patients for insurance-related issues, demonstrating a strong understanding of Medicare/Medicaid rules, managed care products, and current contracted/non-contracted healthcare insurance plans.
• Reviews patient electronic medical records for appropriate diagnosis and pre-treatment rendered, with a thorough understanding of CPT and ICD-10 coding.
• Consults with physicians and their assistants to ensure timely approvals and follows through on corrections in demographics and insurances.
• Monitors Referral In-Basket in EPIC to ensure work is completed in a timely manner, including pre-authorizing future test requests within insurance-specified time frames and notifying patients.
• Facilitates pre-authorization of diagnostic exams between referring physicians and insurance carriers using online tools, work lists, and direct phone calls.
• Ensures all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared for maximum and timely reimbursement.
• Interacts with various hospital departments and physicians' offices to schedule and direct patients through NMHC systems in a patient/customer-friendly manner.
• Performs medical necessity checks for scheduled services, communicates options to patients if appointments fail, and informs patients of financial account issues.
• Completes out-of-pocket estimations as requested by patients.
• Provides training and education as needed and manages work schedule efficiently to complete tasks on time.
• Participates in Quality Assurance reviews to ensure integrity of patient data information.
• Uses effective service recovery skills to solve problems or service breakdowns and adheres to department and hospital policies and procedures.
• Performs duties within the regulatory guidelines of the Fair Patient Billing Act and the Fair Debt Collection Act.
• Communicates information to patients regarding physician referrals, insurance referrals, and consultations, collecting authorization numbers in appropriate systems.
• Provides a professional and constructive environment for communication across units/departments and resolves operational issues.
• Attends intra/interdepartmental meetings and communicates customer satisfaction issues to appropriate individuals.
• Demonstrates teamwork by assisting co-workers within and across departments, respecting diverse opinions and styles.
• Ensures outpatient procedures have a valid diagnosis code and that medical necessity is met for Medicare patients.
• Communicates with physician offices to troubleshoot failing medical necessity for Medicare patients.
• Contacts patients to notify them of high out-of-pocket liabilities and enforces compliance with hospital financial policies.
• Reviews and analyzes all required demographic, insurance/financial, and clinical data to expedite payment on patient accounts.
• Verifies eligibility and benefit information using online programs and performs pre-certification notification via telephone or electronically.
• Gathers and completes all required documentation for submission to insurance carriers per payor requirements.
• Participates in researching pre-certification denials, including missing authorization or documentation.
• Works on denied accounts with ancillary departments, physicians, and account representatives to gather required information.
• Cross-trains between various departments to ensure coverage.
• Utilizes multiple online order retrieval systems to verify or print patient orders.
• Verifies insurance eligibility and benefit levels through online tools or phone as necessary.
• Completes accurate handoff instructions and notes to scheduling staff in Epic.
• Demonstrates ability to use all computer applications efficiently and to the capacity needed in this position.
• Proactively prevents issues with patient visits by double-checking test types, preps, conflicts, time, and location, documenting order retrieval in notes.
• Understands the minimum data set required for complete registration, collecting and verifying critical data.
• Understands departmental and individual quality metrics, proactively analyzing account activity and initiating appropriate actions.
• Evaluates procedures and suggests improvements to enhance customer service and operational efficiency.
• Participates in departmental quality improvement activities and provides ideas for process improvements.
• Monitors registration and scheduling, including insurance verification, to ensure processing within prescribed quality standards.
• Adjusts processes as needed to meet standards and uses organizational resources efficiently.
• Acts as a training resource for new staff and a resource for coworkers, sharing process and workflow information.
• Performs other duties as assigned.

Requirements

• High School Diploma or equivalent.
• 2-3 years of previous hospital billing, insurance follow-up, or customer service in a hospital setting.
• Excellent interpersonal, verbal, and written communication skills.
• Proficiency in computer data-entry/typing.
• Ability to read, write, and communicate effectively in English.
• Basic computer skills and ability to type 40 wpm.
• Ability to multi-task.
• Customer service-oriented with excellent organizational, time management, analytical, and problem-solving skills.

Preferred Qualifications

• Bachelor’s Degree.
• Additional language skills.
• Healthcare finance and/or healthcare insurance experience.
• Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration.