Financial Clearance Verification Specialist

Overview: Who we are Our award-winning Bariatric Practice is based on providing exemplary customer service, while assisting patients to achieve their weight loss goals. With the support of our employees and our team of skilled bariatric surgeons, we use innovative systems to successfully get our patients on the path to improved health. We serve patients in New York, New Jersey and Connecticut. How youll serve our patients Every day is an opportunity to grow and provide better outcomes at every level. Whether your interests lie as medical staff, administrative, facilities or marketing, every individual plays an important part in our success and the success of our patients. We are a fast-paced growing practice that is always looking for new talent and great employees to enhance our team. You will serve patients daily in a multitude of ways: What is in it for you Free Medical Insurance, Dental & Vision Insurance, 401k & 4% Match, Employer Paid Life and AD&D insurance, Paid Time Off and Sick Time, 7 Holidays, Career Growth & Development Compensation for this position ranges between $25 - $30 per hour depending on experience Responsibilities: In this role, the successful candidate under the general direction of the RCM Director, Financial Clearance Manager and the assigned Supervisor, the Financial Clearance Associate (FCA) is responsible for performing accurate and timely insurance clearance functions pre and post service to ensure maximum hospital reimbursement and mitigate insurance denials. Health system responsibilities for the FCA include, but are not limited to: 1) verifying insurance eligibility and determining patients insurance coverage and insurance authorization requirements, 2) obtaining and documenting pre-authorizations and pre-certifications, 3) verifying coverage levels, 4) utilizing the other platforms for Estimate tool to calculate patients estimated patients financial responsibility and ensuring OOP amounts are communicated to the patient pre-service, 5) working cases timely and efficiently from the systems Worklist/workflow as assigned, 6) collecting pre-service time of payments and 7) providing exceptional customer service to both internal and external stakeholders. Supports and demonstrates the Philosophy/Mission of NYBG 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 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 AMD. 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 payor type. Calculates and communicates patients estimated out of pocket professional-services financial responsibility pre-service for scheduled or prospective services utilizing the Estimator tool. 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, physicians, physician office staff, and hospital colleagues. Demonstrates excellent communication skills; uses appropriate vocabulary and grammar when obtaining and conveying information to physicians, nurses and staff at various levels; in person, over the phone, in writing and in electronically sent messages. Works collaboratively with and acts as a liaison with a variety of internal departments within NYBG. Works independently, takes initiative, and escalates to leadership appropriately. Responsible for answering and redirecting phone calls as needed and responding to emails timely. Adhere to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required trainings, and other NYBG mandated activities. Perform other duties as assigned. SKILLS : Strong knowledge of front-end hospital, medical office, patient access, revenue cycle and /or practice operations Knowledge of medical and insurance terminology. Knowledge of insurance benefit verification tools including payor portals, RTE, etc. Ability to perform with accuracy and attention to detail for meeting payer-imposed deadlines on a daily basis. Ability to compose and edit logical, detailed, comprehensive, and grammatically correct correspondence. Ability to communicate effectively with a wide variety of personnel including patients, families, physicians, and staff. Experience and competency with varied computer hardware and software, including registration and billing systems, word processing, spreadsheet, database, scheduling, communications. Ability to handle matters of highly confidential and sensitive nature. Ability to recognize and identify problems, recognize implications and propose alternative solutions. Skill in working independently and in following through on assignments with minimal direction. Qualified candidates must be able to effectively communicate with all levels of the organization. Qualifications: Minimum Education: High school diploma and some college, preferred. Minimum Experience: 1-2 years of billing and/or registration experience in a healthcare organization, preferred. 1 year related experience in a high traffic, confidential environment. Must be well organized with demonstrated ability to deal with all levels of the general public and upper management. Must be customer focused, service excellence and team player. Must support all functions of the practice and enhance the overall patient experience. Must have the ability to work independently without a lot of direct management oversight. Physical Requirements: Work is sedentary with intermittent walking and standing; operates a Personal Computer; requires abilityto handle patients and family members under stressful conditions.

Created: 2024-11-05