Senior Financial Clearance Specialist, Day

Job Requirements

• Coordinates administrative and financial components of financial clearance, including validation of insurance coverage and benefits, medical necessity validation, routine and complex pre-certification and prior authorization, scheduling and pre-registration, patient benefit and cost estimates, pre-collection of out-of-pocket cost share, and financial assistance referrals.
• Manages service line and/or complex multi-payer insurance verification, benefit eligibility validation, and prior authorizations, including obtaining and completing required documentation for pre-certification and referral/authorization processes.
• Performs root-cause analysis related to no-authorization denials.
• Maintains regular communication and follow-up with patients and families to keep them informed of financial clearance status and self-pay responsibilities.
• Maintains regular communication and follow-up with program and department contacts regarding pending insurance, coverage determinations, and other payment-related matters.
• Develops denial mitigation strategies in collaboration with staff in registration, patient financial services, and clinical areas, as applicable.

Primary Responsibilities

• Coordinates patient, insurance, and financial clearance activities for both scheduled and non-scheduled appointments, including validation of insurance coverage and benefits; routine and complex pre-certifications and prior authorizations; and scheduling and pre-registration.
• Triages complex financial clearance work.
• Manages service line and/or complex multi-payer insurance verification, benefit eligibility validation, and prior authorizations, including obtaining and completing required documentation for pre-certification and referral/authorization processes.
• Performs root-cause analysis related to no-authorization denials.
• Maintains regular communication and follow-up with patients and families to keep them informed of financial clearance status and self-pay responsibilities.
• Maintains regular communication and follow-up with program and department contacts regarding pending insurance, coverage determinations, and other payment-related matters.
• Develops denial mitigation strategies in collaboration with staff in registration, patient financial services, and clinical areas, as applicable.