Financial Clearance Specialist - Authorizations Oncology

2 days ago

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Revenue Cycle Management • HIM • Patient Engagement • Revenue Integrity • Accounts Receivable Management

1001 - 5000

Description

• Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out-of-pocket cost share and financial assistance referrals. • Initiates and tracks referrals, insurance verification and authorizations for all encounters. • Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles. • Works directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier. • Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status. • Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements. • Reviews and follows up on pending authorization requests. • Coordinates and schedules services with providers and clinics. • Research delays in service and discrepancies of orders. • Assists management with denial issues by providing supporting data. • Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing. • Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services. • Assists Medicare patients with the Lifetime Reserve process where applicable. • Reviews previous day admissions to ensure payer notification upon observation or admission. • Answer incoming patient or client call/email requests and handle in a prompt, courteous and professional manner. • Communicate effectively with patient by simplifying complex information.

Requirements

• Proficient knowledge of Medicare, Medicaid MCO Plans, Manage Care and Commercial Insurances as it relates to account receivables. • Knowledge of medical terminology, anatomy and physiology, and ICD-10 and CPT/HCPCS code sets. • Minimum 3-5 years of experience in health care billing and reimbursement analysis. • Knowledge of medical and insurance terminology, specifically regarding oncology and infusions. • Excellent verbal communication, telephone etiquette, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies. • Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues. • Ability to prioritize work based on criticality and re-prioritize as STAT cases are submitted. • Demonstrate dependability, critical thinking, and creativity and problem-solving abilities. • Applies critical thinking skills to identify and resolve problems proactively and identify patient responsibility. • Basic working knowledge of UB04 and Explanation of Benefits (EOB). • Knowledge of the Patient Access and hospital billing operations of Epic. • Outstanding organization and time management skills. • Proficient computer knowledge including MS Office with ability to enter data, sort and filter excel files.