Financial Clearance Center Representative

Financial Clearance Center Representative

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Overview

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence‑based practice to improve outcomes—to every patient, every time.

We are committed to caring for Long Island and are proud to be named Long Island's Top Workplace.

Job Details

The Financial Clearance Representative works with the various components of the insurance verification, insurance notification and authorization, and financial clearance operational activities for Catholic Health for defined acute care and outpatient hospital services. Responsibilities include working in conjunction with Patient Access Services to facilitate on‑site patient communication. The role is responsible for ensuring a patient’s visit is financially secured, which requires communication with patients, physicians, office staff, clinicians, and insurance companies to obtain and accurately record patient demographic and insurance information.

The role also includes verifying patient insurance coverage, notifying payers for non‑scheduled admissions, and pre‑certification/authorization requirements via phone or through an online system to secure authorizations for scheduled procedures prior to the date of service.

• Utilize work queues/work drivers and reports as assigned by management to complete daily tasks.
• Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure; may be completed multiple times before, during, and after a patient’s visit/stay.
• Document a patient’s health insurance benefits and coverage for their visit including effective date of the policy, product line, coverage limitations / requirements, and patient liabilities for the type of service(s) provided.
• Check benefits to determine deductible, coinsurance, and copayment amounts due.
• Use procedure estimate process/program to notify the patient in advance of the amount due.
• Make patients aware of financial obligations and appropriately refer them to financial counseling when necessary.
• Collect co‑payments, co‑insurance, deductible and self‑pay fees prior to or at the point of service; document collections in the system and on a daily collection log, and provide patient with receipt.
• Verify a patient’s network status (in or out‑of‑network) with their plan and communicate to the patient in advance if an out‑of‑network status applies.
• Ensure payer requirements are met, including verifying and documenting insurance eligibility; confirm and document benefits.
• Notify the insurance carrier for non‑scheduled services (Emergency room admissions and observation status).
• Review and analyze patient visit information to determine whether authorization is needed and understand payer‑specific criteria to appropriately secure authorization and clear the account prior to service where possible.
• Ensure that initial and all subsequent authorizations are obtained in a timely manner and maintained on designated patients.
• Review visit data to ensure appropriate and accurate information is provided to the payer to support the authorization request.
• Utilize analytical, problem‑solving skills to determine the best course of action to resolve any admission problems created as a result of insurance coverage or prior authorizations.
• Work closely with various departments to secure prior‑approval/authorizations.
• Ensure financial clearance for unscheduled patients is initiated within 24 hours of admission/arrival.
• Coordinate with onsite Case Management and Utilization Management to guarantee payer requirements are met for inpatient and 23‑hour observation patients.
• Coordinate with various departments to ensure consistent financial clearance of FCC in‑scope services.
• Foresee and communicate to management…