Financial Clearance Specialist

* Verify insurance eligibility, benefits, and patient liability to prevent denials or penalties.
* Accurately document insurance and payment information to optimize reimbursement and avoid write-offs.
* Maintain up-to-date knowledge of insurance plans, contract requirements, and best practices for insurance verification.
* Confirm and secure benefits coverage with insurance companies and employers; ensure demographic data is correct.
* Cross-reference Medicare accounts and coordinate benefit statuses as needed.
* Determine and process pre-certification or referral requirements per protocol.
* Communicate with providers regarding out-of-network barriers and document accordingly.
* Estimate and collect patient liability prior to service, following cash management policies.
* Maximize collection of co-pays and other balances per department protocol.
* Review and resolve accounts on hold to ensure timely billing.
* Partner with the Authorization team to obtain payer authorizations and referrals.
* Ensure compliance with HIPAA and all insurance process regulations.
* Continue developing your skills to keep up with changes in insurance and reimbursement rules.
* Maintain regular and consistent attendance as scheduled by department leadership.
* 2+ years of experience in registration, financial clearance, or patient financial services, with strong healthcare insurance knowledge.
* Excellent understanding of insurance coverage, benefit verification, and reimbursement rules.
* Strong math and analytical skills.
* Proficiency with Microsoft Office Suite and the ability to learn new software.
* Highly organized, detail-oriented, and able to set priorities.
* Excellent verbal and written communication skills; comfortable interacting with a variety of audiences.
* Strong interpersonal skills with professionalism, tact, and diplomacy.
* Critical thinker; works well independently and as part of a team.
* Commitment to confidentiality and team collaboration.
* Associate’s or Bachelor’s degree.
* Experience with managed care coverage, reimbursement, medical terminology, and medical coding.
* Background in medical office or hospital setting.
* Minimum of two (2) years’ work experience in registration, financial clearance or patient financial services with strong working knowledge of healthcare insurance and benefit programs required. Associate’s or Bachelor’s degree preferred.
* Excellent knowledge of applicable rules and guidelines governing traditional insurance coverage and reimbursement required.
* Strong math and analytic skills required.
* Possess and maintain computer skills to include working knowledge of Microsoft Office Suite required.  Possess ability to learn other software as needed.
* Strong working knowledge of applicable rules, regulations and guidelines governing managed care coverage and reimbursement preferred.
* Background knowledge and understanding in medical terminology and medical coding preferred.
* Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
* Commitment to working in a team environment and maintaining confidentiality as needed.
* Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
* Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
* Obtains reports needed to begin insurance verification processes that are outside of Meditech Worklists.
* Confirms eligibility and secures full benefits coverage information with insurance companies and employers. Confirms demographic information is correct and assures coordination of benefits (COBs) and insurance plan codes are accurate.
* Verifies Medicare accounts, cross-referencing traditional Medicare and other providers as required. Determines number of prior Medicare days and reviews system to determine appropriate status. Notifies the physician office if the admit status needs to be changed.
* Verifies insurance coverage for inpatient and outpatient accounts per department protocol.
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