What are the responsibilities and job description for the Financial Clearance Associate - Full Time, Days position at NYU Langone?
NYU Langone Hospital—Suffolk is a 306-bed medical center, providing care to residents of eastern Long Island. The hospital facility is home to the Knapp Cardiac Care Center—an advanced heart disease diagnostic and treatment facility—as well as a modern ambulatory surgical pavilion with specialized services including women’s imaging, a sleep laboratory, and bariatric surgery. Our Provisional Level 2 Trauma Center delivers comprehensive and specialized care for patients with traumatic injuries. The Stroke Center at NYU Langone Hospital—Suffolk is designated by the New York State Department of Health as a Primary Stroke Center, with expert neurologists available to provide treatment 24 hours a day, 7 days a week. Additionally, NYU Langone Hospital—Suffolk has multiple outpatient sites, including an outpatient wound care center, a hemodialysis center, and various primary care and specialty offices. For more information, go to NYU Langone Hospital—Suffolk , and interact with us on LinkedIn, Glassdoor, Indeed, Facebook, Twitter, YouTube, and Instagram.
Position Summary:
We have an exciting opportunity to join our team as a Financial Clearance Associate - Full Time, Days - FIN-Insurance Verif/Cust Svc - Full-Time - 09:00 AM- 05:00 PM.
In this role, the successful candidate Under the general direction of the RCO Director and the assigned RCO Associate Director/Sr Manager/Manager/ Supervisor the RCO Financial Clearance Associate FCA is responsible for performing accurate and timely insurance clearance functions pre and post service to ensure maximum hospital reimbursement and mitigate insurance denials Health system responsibilities for the FCA include but are not limited to: 1 verifying insurance eligibility and determining patients insurance coverage and insurance authorization requirements 2 obtaining and documenting pre authorizations and pre certifications 3 verifying coverage levels 4 utilizing the Epic Estimate tool to calculate patients estimated hospital financial responsibility and ensuring OOP amounts are communicated to the patient pre service 5 working cases timely and efficiently from the Epic Work Queues/DAR as assigned 6 collecting pre service time of payments and 7 providing exceptional customer service to both internal and external stakeholders and facilitating RCO and patient financial needs Supports and demonstrates the Philosophy/Mission of LICH in the performance of duties and representation
Job Responsibilities:
- This position is responsible and accountable for the timely and accurate insurance clearance of pre and post inpatient and outpatient accounts from Epic Work Queues as assigned.
- Performs insurance benefits verification to confirm eligibility for scheduled or prospective services.
- Reviews for appropriate coordination of benefit and identifies discrepancies prior to clearance.
- Determines insurance authorization requirements for services scheduled or received.
- Ensures all scheduled services are authorized and appropriate notification and/or referral is obtained prior to the date of service to ensure payment for services.
- Ensures clear and timely documentation of all insurance clearance activities and outcomes, including authorization information in Epic. Performs all required follow-up to secure authorization pre-service, including follow-up with providers’ offices, scheduling departments and insurance companies.
- Performs medical necessity review for applicable services to ensure diagnosis is covered under insurance carrier clinical bulletin policy for outpatient appointments as scheduled.
- Determines patients’ benefit level based on in-network or out-of-network benefits.
- Identifies non-par plan status and follows appropriate out of network workflow based on service and payor type. Calculates and communicates patients’ estimated out of pocket hospital financial responsibility pre-service for scheduled or prospective services utilizing the Epic Estimator tool or International Calculator.
- Understands performance measures and is accountable for meeting monthly target goals as determined based on service and payer.
- Exercises skill in prioritizing assignments in order to complete work in a timely manner when there are changes in workload, assignments, and pressures of deadlines, competitive requirements and/or a heavy workload.
- Demonstrates optimal customer service skills when interfacing with patients, patients’ families,
physicians, physician office staff, and hospital colleagues.
- Demonstrates excellent communication skills; uses appropriate vocabulary and grammar when obtaining and conveying information to physicians, nurses and staff at various levels; in person, over the phone, in writing and in electronically sent messages.
- Works collaboratively with and acts as a liaison with a variety of internal departments within NYULH, external business partners, external departments, and NYULH’s contracted payers.
- Works independently, takes initiative, and escalates to leadership appropriately.
- Responsible for answering and redirecting phone calls as needed and responding to emails timely.
- Adhere to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required trainings, and other Hospital mandated activities.
- Perform other duties as assigned.
Minimum Qualifications:
To qualify you must have a High School Diploma and 1 year experience in patient accounts or related field or an equivalent combination of education and experience Strong knowledge of front end hospital medical office patient access revenue cycle and /or practice operations Knowledge of medical andi nsurance terminology Knowledge of insurance benefit verification tools including payor portals RTE etc Ability to perform with accuracy and attention to detail for meeting payer imposed deadlines on a daily basis Ability to compose and edit logical detailed comprehensive and grammatically correct correspondence Ability to communicate effectively with a wide variety of personnel including patients families physicians and staff Experience and competency with varied computer hardware and software including registration and billing systems word processing spreadsheet database scheduling communications Ability to handle matters of highly confidential and sensitive nature Ability to recognize and identify problems recognize implications and propose alternative solutions Skill in prioritizing assignments to complete work in a timely manner Skill in working independently and in following through on assignments with minimal direction
Preferred Qualifications:
Associates degree plus 2 3 years of experience in hospital admissions patient accounts or medical records or in related field Epic experience
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Hospital—Suffolk provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you’ll feel good about devoting your time and your talents.
NYU Langone Hospital—Suffolk is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.
View NYU Langone Hospital—Suffolk’s Equal Employment Opportunity (EEO) policy. Know Your Rights: Workplace discrimination is illegal.
NYU Langone Hospital—Suffolk provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $52,942.50 - $52,942.50 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
View the Pay Transparency Notice for further details.
Salary : $1,000 - $1,000,000
