FINANCIAL CLEARANCE SPLST II

Responsibilities

• Requesting authorizations for all types of services provided at Moffitt Cancer Center through all health insurance payors by form of website portal navigation, physical faxed requests to health plans/PCP offices, and manual phone calls to health plans/PCP offices.
• Authorization requests demand/entail navigation through clinical records/documentation and a basic comprehension of clinicals/medical oncology within a clinical chart
• Basic knowledge of coding (both diagnosis and service) for proper submissions of authorization
• Provide clinical information to the health plans or physician’s offices by answering clinical questions online or over the phone, or providing specific clinical documentation via fax for review
• Reading/understanding clinical orders from providers to submit authorizations for the proper services
• Navigating through appointment center tool to advise on what is needed for approaching services
• Navigating certain software’s for legal/HIPPA compliance i.e. Trace, pixcert, Soarian, XR (Cerner)
• Thorough documentation of cases for optimal clarity and uniformity amongst the department
• Calling health insurances, primary physicians offices, and patients/families to relay/receive information regarding authorizations/coverage
• Communicating between other departments including Clinical Trial Coordinators, Patient Appointment Center and Business Office to aid in patient’s needs for coverage
• Submitting appeals and reconsiderations via phone calls or fax when situation permits for better/extended attempt at coverage for patients
• Calling/notifying patients when coverage cannot be obtained
• Managing assigned worklists to ensure patients services are covered in ample amount of time before appointment date
• Navigating worklists including data input, documentation, filtering and working in conjunction with RPA (automation)
• Maintaining a steady workflow to ensure the assigned worklists do not fall behind and is ever current
• Following up on all encounters within the worklists by calling health plans, checking submissions via web, and reviewing the fax box for vital information regarding case approvals, denials
• Balancing one or more worklists at any given time by prioritizing with time management skills to ensure patients are granted approval in a timely manner
• Completing specific metrics of encounters on the worklists daily to ensure timely patient care
• Responding to correspondence received from payer and/or patients
• Ensuring proper multi-tasking to manage worklists assignments between calls
• Ensuring collection and documentation are correct and appropriate action taken place is documented
• Meting or exceeding established productivity goals; notifying Supervisor, when necessary, of issues preventing achievement of such goal(s) per departmental Operational Guidelines
• Demonstrates proactiveness when not meeting Productivity Goals based on Hours Worked by reaching out for re-education/game plan to get back on track
• Meting or exceeding monthly QA score per department guidelines
• Accepts feedback from supervisor each month
• Follows procedures outlined in operational guidelines and score cards
• Communicates professionally, timely and effectively in English, both verbally and in writing
• Actively participates in monthly Peer Reviews, Team staff meetings, Departmental meetings, etc.
• Cooperates, collaborates and creates an atmosphere of teamwork and camaraderie with team members and others
• Maintain positive departmental and interdepartmental relationships, keeping a positive attitude and adhering to the policies and procedures of the department and organization
• Exhibits a high level of critical thinking skills while following the departmental chain of command
• Maintains a high level of professionalism during phone call with patients, outside facilities and other departments
• Displays excellent customer service during calls, with emphasis on delivering accurate and complete information
• Ensures proper research, problem solving and provides resolution to callers
• Ensures effective escalation of caller's requests to the assigned team

Qualifications

• High School Diploma/GED
• Minimum of six (6) months of experience as a Financial Clearance Specialist Level I and meet all requirements of Financial Clearance Unit Promotional Program for Level II
• Or A minimum of two (2) years recent patient registration, insurance verification and/or insurance precertification/authorization with a healthcare provider or insurance company
• Preferred Experience - For Infusion team, experience in scheduling, registration or related functions in a Chemotherapy setting
• For Radiation Therapy, experience in scheduling, registration or related functions in a Radiation Therapy setting
• For Surgical, experience in scheduling, registration or related functions in a surgical setting
• For BMT, CAR-T, Clinical Trials, experience in scheduling, registration or related functions in one of these settings
• For Full Verification, experience in insurance verification and knowledge of insurance networks and contracting
• For FCU Hotline Team, experience working in a call center environment
• HFMA Certified Revenue Cycle Representative (CRCR) certification is a plus
• Preferred Skills/Specialized Training - Proficiency with Microsoft Office – Word, Outlook and Excel
• Knowledge of guidelines and authorization process for commercial and government insurances
• Ability to manage multiple, competing priorities
• Possess effective oral and written communication skills
• Be assertive, highly motivated and be able to work independently
• Possesses excellent Time Management and Organizational Skills
• Proficiency in computer skills (speed and accuracy)