Financial Clearance Specialist
- . Must preserve all substantive info. We'll need to break each sentence into list items. There's also sub-sections like "Communication and Collaboration:" and "Technology:" and "Efficiency, Process Improvement, and Business Growth:" but those are still responsibilities. We'll treat them as part of responsibilities list.
- Requirements: The posting has "Qualifications Required:" and "Preferred:" plus maybe "AA/EOE". Also "Qualifications" heading maybe. We need to separate Requirements vs Qualifications vs Skills. The instruction: Use headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we need to decide what goes where. Typically Requirements = required qualifications. Qualifications = maybe preferred? Skills = maybe skills like communication, computer, typing speed. But we can map: Required qualifications under Requirements. Preferred qualifications under Qualifications. Skills maybe under Skills (like interpersonal, verbal, written communication, computer data-entry/typing, ability to type 40 wpm, multi-task, customer service oriented, organizational, time management, analytical, problem solving). However many of those are also qualifications. But we need to follow instruction: Use headings only when posting has real specific content for it. We have content for Requirements (required), Qualifications (preferred), Skills (maybe we can list skills). We'll need to avoid duplication. Let's extract:
Required:
- High School Diploma or equivalent.
- 2-3 years 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.
- Excellent verbal and written communication skills. (duplicate)
- Ability to read, write, and communicate effectively in English.
- Basic computer skills.
- Ability to type 40 wpm.
- Ability to multi-task.
- Customer service oriented.
- Excellent organizational, time management, analytical, and problem solving skills.
Preferred:
- Bachelors Degree.
- Additional language skills.
- Healthcare finance and/or healthcare insurance experience.
- Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration.
Skills: Could be things like "Excellent interpersonal, verbal, and written communication skills", "Proficiency in computer data-entry/typing", "Ability to type 40 wpm", "Ability to multi-task", "Customer service oriented", "Excellent organizational, time management, analytical, and problem solving skills". But those already appear in required. Might be okay to put them under Skills and not duplicate under Requirements? But we need to preserve all substantive info; we can keep them in both places? The instruction says do not invent or summarize away detail. Duplication is okay if it's in the source? The source has duplicates (e.g., excellent verbal and written communication skills appears twice). We should preserve duplicates as they appear? Probably we should keep them as they appear but we can avoid repeating same sentence verbatim if it's duplicate; but it's okay to keep once. However we need to not lose any info. If we put a skill under Skills and also under Requirements, we are duplicating but not losing. Might be acceptable but could be considered redundant. The instruction: "Preserve ALL substantive information; do NOT invent or summarize away detail." It doesn't forbid duplication. But better to avoid unnecessary duplication but still keep all info. We could assign each piece to appropriate section without duplication. Let's try to map:
Requirements (mandatory):
- High School Diploma or equivalent.
- 2-3 years previous hospital billing, insurance follow-up, or customer service in a hospital setting.
- Ability to read, write, and communicate effectively in English.
- Basic computer skills.
- Ability to type 40 wpm.
- Ability to multi-task.
- Customer service oriented.
Qualifications (preferred):
- Bachelors Degree.
- Additional language skills.
- Healthcare finance and/or healthcare insurance experience.
- Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration.
Skills:
- Excellent interpersonal, verbal, and written communication skills.
- Proficiency in computer data-entry/typing.
- Excellent organizational, time management, analytical, and problem solving skills.
But we omitted some like "Excellent verbal and written communication skills" duplicate; we covered under Skills. Also "Excellent interpersonal, verbal, and written communication skills" is there. Also "Proficiency in computer data-entry/typing" is there. Also "Excellent organizational, time management, analytical, and problem solving skills" is there.
We also need to include "Excellent interpersonal, verbal, and written communication skills" maybe also under Skills. Good.
Now Benefits: we have description and list. We'll create Benefits section with a
for description and then
- for each benefit item.
Pay: we have salary range and placement factors. We'll put in
. Schedule: none, omit. About the role: we have description paragraph starting "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." That's about the role. We'll put that in
. Responsibilities: we need to extract all responsibilities sentences after "Responsibilities:" until before "Communication and Collaboration:"? Actually the responsibilities section includes many items, then there are headings like "Communication and Collaboration:", "Technology:", "Efficiency, Process Improvement, and Business Growth:" which are subcategories but still responsibilities. We'll treat each sentence as a list item. We need to parse the responsibilities block. Let's copy the responsibilities text: "Responsibilities: Consistently practices Patients First philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphere.Responds to questions and concerns.Forwards, directs and notifies Team Lead or Operations Coordinator of extraordinary issues as necessary.Maintains patient confidentiality per HIPAA regulations.Provides exceptional customer service to consumers which establish a positive first impression of Northwestern Medicine.Exceeds all consumer requests and alerts management of issues or concerns that require escalation.Correctly identifies and collects patient demographic information in accordance with organization standards.Responds to telephone inquiries and performs appropriate action(s).Documents all actions taken 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.Has a strong understanding of Medicare/Medicaid rules and regulations, and managed care products.Is knowledgeable of current contracted and non-contracted healthcare insurance plans.Reviews patient electronic medical record for appropriate diagnosis and pre-treatment rendered.Has thorough understanding and working knowledge of CPT and ICD-10 coding.Consults with physicians and their assistants whenever questions arise to insure timely approvals.Follows through and makes corrections in demographics and insurances as they are discovered.Data entry accuracy is imperative in this position.Monitors Referral In-Basket in EPIC to insure work is consistently completed in a timely manner.This involves watching for future test requests to come due and then pre-authorized within the time frame specified by the insurance carrier and the patient notified.Facilitates the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, through the use of online tools, work lists, and direct phone calls as necessary to ensure maximized patient benefits.Ensures all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared, to allow for maximum and timely reimbursement to the hospital.Interacts with various hospital departments and physicians offices to effectively schedule and direct patients through the NMHC systems in a patient/customer friendly manner.Performs medical necessity checks as necessary for scheduled services, communicates options to patient if appointment fails.Informs patients of any issues with securing the financial account for their encounter and completes out-of-pocket estimations as requested by patients.Provides training and education as needed.Manages work schedule efficiently, completing tasks and assignments on time.Participates in Quality Assurance reviews to insure integrity of patient data information.Uses effective service recovery skills to solve problems or service breakdowns when they occur.Utilizes department and hospital policies and procedures to complete assigned tasks.Performs duties within the regulatory guidelines of the Fair Patient Billing Act and the Fair Debt Collection Act.Other duties as assigned.Communication and Collaboration:Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations.Collects authorization numbers in appropriate systems as applicable.Provides professional and constructive environment for communication across units/departments and resolves operational issues.May attend intra/interdepartmental meetings which involve walking within NM Campus.Communicates customer satisfaction issues to appropriate individuals.Demonstrates teamwork by helping co-workers within and across departments.Communicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of others.Ensures that outpatient procedures have a valid diagnosis code, and that for Medicare patients, medical necessity has been met.Communicates with physician offices to troubleshoot failing medical necessity for Medicare patients.Contacts patients to notify them of high out-of-pocket liabilities, and to establish/enforce compliance with hospital financial policies.Reviews and analyzes all required demographic, insurance/financial and clinical data procured by patient intake and registration areas necessary to expedite payment on patient accounts.Verifies eligibility and benefit information using on-line programs.Performs pre-certification notification via telephone or electronically and gathers and completes all required documentation for submission to insurance carriers per payor requirements.Participate in researching pre-certification denials including missing authorization, patient pre-certification or referral documentation.Works on denied accounts with ancillary departments, physician and account representatives to gather required information.Cross-training between various departments may take place to insure coverage.Technology:Utilizes multiple online order retrieval systems to verify or print the patients
- for each benefit item.
Pay: we have salary range and placement factors. We'll put in