Description

 Job Summary (Summary of the basic functions of the position)

The Patient Financial Clearance Specialist is responsible for the insurance verification of eligibility and benefits for scheduled patients. Follows US Dermatology Partners policies and procedures for insurance verification timeliness and out of network scheduling practices, maintaining strict confidentiality for all patient accounts. Responsible for short-term and long-term patient financial clearance projects, as assigned.

Duties and Responsibilities (Responsibilities necessary to accomplish job functions)

• Verify that sufficient information is available for accurate verification and eligibility.
• Determine if a secondary and/or tertiary insurance should be added to the patient’s account ensuring the appropriate payer is selected for Primary insurance.
• Accurately ensure coordination of benefits (COB) is calculated and set up accordingly in NextGen.
• Utilize Rivet, Availity, payer portals and/or contact insurance companies to obtain eligibility, benefits, and/or referral and authorization information.
• Enter the patient insurance information into NextGen ensuring the selection is the appropriate payer and associated financial class.
• Follow the Policies and Procedures when accepting Out of Network payers along with notifying the patient immediately.
• Ensures each patient’s insurance verification is completed and accurate. Document findings in the patient account and contact the patient with either estimated co-insurance, co-pay, and or deductible amounts due on or before the date of service when applicable.
• Contacts each patient as part of center compliance with CMS Conditions for Coverage guidelines in contacting patients prior to the date of service to review patient’s responsibility.
• Check insurance company approved procedure lists/medical policies. Notify patient if procedure is not payable and options per USDP’s Self-Pay agreement.
• Obtain authorizations and/or referrals from insurance companies/physician’s offices. Ensure complete and accurate information is included on the authorization and entered into NextGen.
• Contact the patient and communicate USDP’s financial policy, when applicable.
• Resolve Claim Edits associated with authorizations, demographics, and insurance.
• Track and report trending data associated with claim edits to manager.
• Work and resolve patient insurance-related tasks. Track repeat tasks and provide to manager.
• Assist with workflow optimization through piloting new procedures, applications, and policies. Track and report findings to manager.
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.

Qualifications

 Experience Requirements

• 1 years of work experience in medical insurance verification and/or patient financial clearance
• 1 years of work experience in PCP Referral and/or Prior Authorization initiation and follow-up

Knowledge, Skills and Abilities Requirements

• NextGen, Availity and Rivet experience, preferred
• Knowledge of Coordination of Benefits, preferred
• Familiar with individual payer guidelines and the process of collecting in office payments/deductibles/copay/co-insurance.
• Knowledge of payer contracts including Medicare, Commercial and other government contracts, and guidelines.
• Detail oriented, professional attitude, reliable
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Ability to work successfully under tight timeframes
• Interpersonal skills to support customer service, functional, and team mate support needs
  • Able to communicate effectively in English, both verbally and in writing
• Mathematical and/or analytical ability intermediate to complex problem solving
• Intermediate computer operation
  • Experience with Microsoft Excel and Word.
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations; general understanding of HIPAA guidelines

 Supervisory Responsibilities:

• This position has no supervisory responsibilities.