Financial Clearance Specialist

Role Description

Responsible for assessing and verifying patient information for scheduled medical services. This requires verification of patient’s demographic, financial, and insurance information. Collects co-pays, deductibles, coinsurances, and down payments. Provides estimates for services when appropriate. Receives and processes patient financial liability payments for current and past balances. The focus is to collect patient liabilities prior to service and to resolve any insurance and financial issues prior to services being rendered. Reschedules appointments when appropriate under the guidance of department leader. This position is the front line for customer service, pre-registration, and access to care for scheduled services.

• Initiates contact with insurance companies to obtain eligibility, gather accurate patient billing information, and performs collections with outstanding accounts receivable.
• Accurately estimates the patient financial liability (copayments, deductibles, coinsurances, deposits, etc. via obtaining accurate demographic and financial information). Answers patient inquiries regarding their liability and able to explain the variables involved.
• Receives and processes patient payments.
• Ensures pre-certification authorization and or referral is in placement prior to service being rendered.
• Appropriately referring patients to Financial Counselors or Business Office dependent on need of patient.
• Reschedules appointments when requested by patient or, under advisement of department leader, when due to financial circumstances appointment requires postponement.
• Enters clear, concise notes concerning financial clearance status in system based on communications.
• Demonstrate knowledge and understanding of all job-related policies and procedures and adheres to and consistently applies the Financial Clearance Policy in all patient cases.
• Assesses gaps in patient coverage to determine patient financial exposure prior to rendering service.
• Consistently demonstrates ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• Performs other duties as assigned, or directed, to ensure smooth operation of the department/unit.

Qualifications

• Minimum High School Diploma, or G.E.D., business concentration preferred.
• Associate degree, or higher, preferred.
• Four plus (4+) years of experience within a business office setting, hospital revenue cycle preferred, Physician office or collection agency.
• Prior experience in a healthcare environment required.
• Working knowledge of personal computers and business office applications preferred.
• Familiarity with hospital computer systems is a plus.
• Knowledge of third party collections and reimbursement preferred.

Requirements

• On-the-job time is spent in the following physical activities:
• Stand - 1/3
• Walk - 1/3
• Sit - 2/3
• Talk or hear - 2/3
• Uses hands to finger, handle or feel - 2/3
• This job requires that weight be lifted, or force be exerted:
• Up to 10 pounds - 1/3

Benefits

• This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process.