Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

About the role

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization.

Responsibilities

• Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient.
• Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization.
• Must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate.
• Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons.
• Determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable.
• Communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps.
• Determine, communicate, and collect patient liability prior to service and attempt to collect prior balances.
• Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative.
• Maintain compliance with HIPAA regulations as it pertains to the insurance processes.
• Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative.
• Submit pre-certification documentation to third party payers for authorization with correct CPT and ICD coding.
• Research payer medical policy requirements for treatment authorizations and understand process for submitting pre-certification requests.
• Follow up for routine requests from the message center are followed up on 3-5 business days consistently.
• Scan all authorizations into appropriate system under the respective patient accounts and document authorization outcomes in the registration system.
• Perform all other duties as assigned.

Qualifications

• High school or equivalent OR GED required.
• 2 years Admitting/insurance verification experience in a hospital, health plan or Physician office environment.
• Broad experience in financial counseling and co-pay collections.
• Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non-invasive procedures is highly desirable.
• The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting.
• Able to interrupt patient’s insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers.
• Strong problem solving customer skills.
• Knowledge of business office procedures.
• Knowledge of medical terminology and coding.
• Knowledge of grammar, spelling, and punctuation to type patient information.
• Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.
• Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
• Able to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.
• Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.
• Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.