Financial Clearance Specialist

Works with Revenue Cycle departments to identify trends, root causes, and corrective actions; presents outcomes to leadership via monthly meetings, presentations and reports.

• Identifies areas of review and completes monthly audits for all service areas.
• Researches payer websites for payer changes and denials; helps create new processes with leader to close any gaps.
• Ensures goals are met as determined by key performance indicators of volume and accuracy of work completed utilizing system tools or processes.
• Follows established department policies related to patient registration, verification of insurance eligibility and benefits, and referral status; collects patient responsibility amounts for services provided throughout the health system.
• Establishes contact with patients via inbound and outbound calls.
• Secures correct financial information, educates on financial responsibilities, collects estimated amount due and / or advises on financial assistance to pre-register patients for future dates of service.
• Verifies insurance eligibility and benefits utilizing a real-time eligibility tool, payer websites, and / or telephone calls to payers.
• Collects and documents payer verification responses in revenue systems; verifies primary care physician (PCP) and demographic information.
• Secures timely authorizations for all services that require authorization per payer regulations.
• Performs other duties as assigned.
• LICENSES AND / OR CERTIFICATIONS

None required.

• MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS

High school diploma or equivalent required.

• Minimum of four (4) years of healthcare experience in operations, registration and / or revenue cycle.
• Excellent customer service skills required to communicate with internal and external clients.
• Demonstrates the ability to solve problems independently or as part of a team.
• Must have excellent organizational and time management skills.
• WORKING CONDITIONS

Normal office environment with little exposure to excessive noise, dust, temperature and the like.

• PHYSICAL REQUIREMENTS

Click here to view physical requirements.

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