Financial Clearance Specialist

Job Summary
The Financial Clearance Specialist is responsible for ensuring financial clearance for services performed at CareWell Health. This role includes obtaining benefits information and validating medical necessity. The specialist reviews the processes related to referral management, scheduling, and registration, ensuring that the accuracy of the tests or procedures being ordered or performed is maintained.

Additionally, the specialist manages insurance portal access to facilitate the financial clearance process. They collaborate and communicate with providers, insurance representatives, patients, and various departments at CareWell Health regarding both scheduled and unscheduled accounts.

Essential Functions 

• Maintains relationship and contacts attorney and provider’s office to collect necessary information to be able to underwrite each case that comes in for the JSSP Program. Responsible for communicating to service line partners of situations where rescheduling is necessary due to lack of authorization and / or limited benefits and is approved by clinical personnel based on defined service level agreements.
• Validates scheduled procedures pass medical necessity verification where appropriate and notifies where Advanced Beneficiary Notices (ABNs) must be gathered from patients in advance if the supplied diagnoses information fails.
• Meets or exceeds productivity standard and audit accuracy goals determined by Revenue Cycle Leadership, meeting timeline standards established by Leadership for all patient services. Ensures integrity of patient accounts by working error reports as requested by Management and/or entering appropriate and accurate data.
• Proactively ensures that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test / procedure or registration being performed. Confirms all benefits, medical necessity, authorizations, pre-certifications, and financial obligations of patients, are documented on account notes, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts for hand-off to Pre-Service Representatives for estimate completion and patient contact to finish pre-registration.
• Maintains a close working relationship with clinical partners and/or ancillary departments to ensure continual open communication between clinical, ancillary and all Revenue Cycle departments. May contact physicians or their staff to facilitate the sending of clinical information in support of the authorization to the payor, as assigned.
• Monitors team mailbox and/or e-mail inbox, faxes, and/or phone calls, responding to all related Financial Clearance account issues, within defined time frames. Exhibits effective time management skills and maintains flexibility by being available for all partners and team. May assists team with reports and projects to maintain team and individual productivity standards and goals.
• In working patient accounts for benefits, monitors accounts for change in insurance status prior to registration and sends updates to appropriate areas for follow up. In working patient accounts for pre-certification, contacts physicians or their staff, schedulers, and clinical service area where appropriate, notifying authorization is not obtained by department deadline, advising of visit cancellation, reschedule, or to obtain life or limb / urgent / emergent order from physician allowing patient to proceed in accordance with defined service level agreements. Contacts patient to notify when visit is rescheduled.
• Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime. Maintains sign-on access to online tools to provide consistent service to patients, clinical partners, schedulers, and Front-End Revenue Cycle Operations team members.
• Assists with the training of others on the process of financial clearance
• Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Minimum Education/Certifications
High School Diploma or equivalent, required.

Minimum of three (3) years of Revenue Cycle experience in a healthcare setting

Minimum Work Experience
Must be detail oriented and have sound computer skills, including but not limited to Word, Excel, and PowerPoint

Experience with review of electronic health records software applications.  Cerner EHR preferred