Financial Clearance Specialist

Summary of Essential Functions

• Performs a wide variety of duties associated with the insurance approval for all applicable services.
• Processes a high volume of insurance requests for services related office visits, diagnostic testing, medications, pre-surgery, operative event and post-surgery follow-up care.
• Responsible for self-pay accounts and estimates.

 

Educational Requirements

• High school diploma or equivalent required.
• Must be able to communicate effectively in English, both verbally and in writing.

 

Knowledge/Skills/Abilities

• Minimum five years of experience in hospital, ambulatory surgery center or medical office.
• Prior experience in ICD10/HCPCS/CPT/DRG coding desired.
• Must be very detailed oriented, with the ability to process a high volume of information under tight time frames.
• Strong computer skills to be able to handle a number of different routines and to understand sometimes complex patient accounts.
• Strong interpersonal skills to handle effectively sometimes sensitive patient account situations. Good communication skills to be able to interact with patients, physicians, insurance representatives, administrative contacts.
• Ability to function independently with only general supervision. Displays initiative and uses good judgment.
• Need to be able to troubleshoot problems, develop workable solutions to problems, and to follow up on problem resolution. Must be able to prioritize work and to handle multiple, sometimes conflicting, tasks using sound judgment.

 

Physical Requirements

• At times, may work under stressful conditions.
• Lifting and carrying items up to 25 pounds.
• Corrected vision and hearing to normal range.
• May require travel between facility locations.

 

Duties and Responsibilities

• Responsible for the accurate discovery and reporting of insurance benefits and approval requirements for patients who seek coverage both internally and externally. Involves thorough understanding of insurer’s medical coverage policies that are updated regularly.
• Responsible for the submission of detailed patient records to insurance carrier in order to obtain office visit, medication, testing and procedure authorization.
• Responsible for obtaining service authorizations, to include, but not limited office visits, diagnostic testing, medications, pre-surgery, operative event and post-surgery follow-up care.
• Responsible for accurate reporting of patient deductibles, co-pays and any insurance plan limitations for office visits, diagnostic testing, medications, pre-surgery, operative event and post-surgery follow-up care.. Information must be shared with all prospective and active patients.
• Responsible for documenting monies received and transfer of monies to billing manager as necessary.
• Handle all telephone inquiries and written inquiries from patients regarding their insurance approval progress within a reasonable period of time.
• Requires familiarity with practice’s charge code structure, third party fee schedules, as well as commonly occurring diagnoses.
• Participates in research and follow up for suspended claims and payment denials from third party payers on all related services. As necessary prepare appeals to third party payers for services.
• Assist with the resolution of outstanding patient accounts receivables related to all billable services.
• Performs all other tasks/responsibilities as necessary.