Financial Clearance Associate

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.

We have an exciting opportunity to join our team as a Financial Clearance Associate—Full Time, Days—FIN-Financial Counsel—Saturday—Wednesday 9:00 AM—5:00 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, is responsible for performing accurate and timely insurance clearance functions pre- and post-service to ensure maximum hospital reimbursement and mitigate insurance denials.

Responsibilities include, but are not limited to: verifying insurance eligibility and determining patients’ insurance coverage and authorization requirements, obtaining and documenting pre-authorizations and pre-certifications, verifying coverage levels, utilizing the Epic Estimate tool to calculate patients’ estimated hospital financial responsibility and ensuring OOP amounts are communicated to the patient pre-service, working cases timely and efficiently from the Epic Work Queues/DAR as assigned, collecting pre-service time of payments, and providing exceptional customer service to both internal and external stakeholders while facilitating RCO and patient financial needs.

Supports and demonstrates the philosophy/mission of LICH in the performance of duties and representation.

• 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 payer 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,…