Financial Clearance Specialist

4 days ago

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Savista

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

1001 - 5000 employees

Founded 1994

⚕️ Healthcare Insurance

Description

• Ensure seamless and accurate processing of financial clearance procedures. • Contact insurance companies, physicians, and patients to collect patient demographic and insurance information. • Inform patients of their rights, financial policies, and collect patient liabilities. • Process and verify administrative and financial components of financial clearance including validation of insurance benefits, medical necessity, routine and complex pre-certification, prior-authorization, scheduling and pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share. • Obtain pre-certifications, authorizations, and referrals for upcoming appointments. • Communicate recommended changes to schedules and care planning to ensure alignment with authorization requests and payor compliance. • Liaison between patient, insurance payors and providers to obtain prior authorization for prescheduled services. • Effectively address issues and offer information and support to both patients and physicians concerning financial clearance matters. • Process stat request prioritization. • Verify demographic information. • Apply payor changes to registration. • Verify, edit and/or remove user defined referral counts editing final status of referrals. • Edit the scheduled date within the referral, pend referrals to any pools, suppressing expiring referrals messages, accessing assigned referral work queues, defer/activate referral work queue items, use referral templates. • Apply critical thinking skills to identify and resolve problems proactively.

Requirements

• High School Diploma or equivalent • 3+ years’ experience with patient registration in a hospital or physician office, directly with obtaining patient demographic and financial information, handling insurance verification and obtaining authorizations • Proficient with commercial and government insurance plans, payer networks, government resources • Proficient with medical and insurance terminology • Strong customer service skills, including ability to understand, interpret, evaluate, and resolve basic to complex service issues. • Strong attention to detail and accuracy • Excellent verbal and written communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, management, patients, client, and external agencies • Ability to work with a variety of stakeholders • Proficient in utilizing a variety of computer applications and software, including but not limited to Microsoft Office Suite, Internet Explorer, and other relevant programs • Proven track record in roles that involve managing multiple critical priorities, with a focus on delivering high-quality results and meeting performance metrics