Financial Clearance Specialist

The salary range for this position is $21.29 - $27.67 (Hourly Rate). Placement within the salary range depends on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement is guided by the rules outlined in the collective bargaining agreement. Northwestern Medicine offers a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well‐being while protecting them for unexpected life events. For more information, visit our Benefits section at jobs.nm.org/benefits. Benefits $10,000 Tuition Reimbursement per year ($5,700 part‑time) $10,000 Student Loan Repayment ($5,000 part‑time) $1,000 Professional Development per year ($500 part‑time) $250 Wellbeing Fund per year ($125 for part‑time) Matching 401(k) Excellent medical, dental and vision coverage Life insurance Annual Employee Salary Increase and Incentive Bonus Paid time off and Holiday pay Description The Financial Clearance Specialist reflects the mission, vision and values of Northwestern Medicine, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and regulatory standards. Responsibilities Consistently practice the Patients First philosophy and adhere to high standards of customer service, setting an example for peers and fostering a team atmosphere. Respond to questions and concerns. Forward, direct and notify the Team Lead or Operations Coordinator of extraordinary issues as necessary. Maintain patient confidentiality per HIPAA regulations. Provide exceptional customer service to consumers, establishing a positive first impression of Northwestern Medicine. Exceed all consumer requests and alert management of issues or concerns that require escalation. Correctly identify and collect patient demographic information in accordance with organizational standards. Respond to telephone inquiries and perform appropriate actions. Document all actions taken in the appropriate software applications. Monitor admission/registration and scheduled surgeries flow of patient information through the revenue cycle. Serve as a resource to staff and patients for insurance related issues. Have a strong understanding of Medicare/Medicaid rules and regulations, and managed care products. Be knowledgeable of current contracted and non‑contracted healthcare insurance plans. Review patient electronic medical record for appropriate diagnosis and pre‑treatment rendered. Have thorough understanding and working knowledge of CPT and ICD‑10 coding. Consult with physicians and their assistants whenever questions arise to ensure timely approvals. Follow through and make corrections in demographics and insurances as they are discovered. Ensure data entry accuracy, which is imperative in this position. Monitor Referral In‑Basket in EPIC to ensure work is consistently completed in a timely manner. Facilitate the pre‑authorization of diagnostic exams between referring physicians and insurance carriers using online tools, work lists, and direct phone calls as necessary to maximize patient benefits. Ensure all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared to allow for maximum and timely reimbursement to the hospital. Interact with various hospital departments and physicians’ offices to effectively schedule and direct patients through the NMHC systems in a patient/customer friendly manner. Perform medical necessity checks for scheduled services, communicate options to patients if appointments fail. Inform patients of any issues with securing the financial account for their encounter and complete out‑of‑pocket estimations as requested. Provide training and education as needed. Manage work schedule efficiently, completing tasks and assignments on time. Participate in Quality Assurance reviews to ensure integrity of patient data information. Use effective service recovery skills to solve problems or service breakdowns when they occur. Utilize department and hospital policies and procedures to complete assigned tasks. Perform duties within the regulatory guidelines of the Fair Patient Billing Act and the Fair Debt Collection Act. Perform other duties as assigned. Communication and Collaboration Communicate information to the patient regarding physician referrals, insurance referrals and consultations. Collect authorization numbers in appropriate systems. Provide a professional and constructive environment for communication across units/departments and resolve operational issues. Attend intra/interdepartmental meetings as required. Communicate customer satisfaction issues to appropriate individuals. Demonstrate teamwork by helping co‑workers within and across departments. Communicate effectively with others, respecting diverse opinions and styles, and acknowledging assistance and contributions. Ensure that outpatient procedures have a valid diagnosis code and, for Medicare patients, medical necessity has been met. Communicate with physician offices to troubleshoot failing medical necessity for Medicare patients. Contact patients to notify them of high out‑of‑pocket liabilities and enforce compliance with hospital financial policies. Review and analyze all required demographic, insurance/financial and clinical data procured by patient intake and registration areas necessary to expedite payment on patient accounts. Verify eligibility and benefit information using online programs. Perform pre‑certification notification via telephone or electronically and gather and complete all required documentation for submission to insurance carriers per payor requirements. Participate in researching pre‑certification denials including missing authorization, patient pre‑certification or referral documentation. Work on denied accounts with ancillary departments, physician and account representatives to gather required information. Cross‑train between various departments as needed to ensure coverage. Technology Utilize multiple online order retrieval systems to verify or print the patient’s order. Verify insurance eligibility and benefit levels through online tools (NDAS, ASF, etc.) or over the phone as necessary. Complete accurate hand‑off instructions and notes to scheduling staff, noting appropriately in Epic. Demonstrate ability to use all computer applications efficiently and to the capacity needed in this position. Efficiency, Process Improvement, and Business Growth Proactively prevent issues with patient visits by double‑checking test types, required preparations, verifying no conflicts, and documenting order retrieval. Understand minimum data set required for a complete registration, collect and verify critical data and update it in the registration system. Understand departmental and individual quality metrics. Proactively analyze account activity, identify problems, and initiate appropriate actions/resolutions. Evaluate procedures and suggest improvements to enhance customer service and operational efficiency. Participate in departmental quality improvement activities. Provide ideas and suggestions for process improvements within the department. Monitor registration and scheduling, including insurance verification, to ensure processing within prescribed quality standards. Adjust processes as needed to meet standards. Use organizational and unit/department resources efficiently. Act as a training resource for new staff and share process and workflow information with coworkers. Qualifications Required: High School Diploma or equivalent. 2‑3 years prior experience in hospital billing, insurance follow‑up, or customer service in a hospital setting. Excellent interpersonal, verbal, and written communication skills. Proficiency in computer data‑entry/typing. Ability to read, write, and communicate effectively in English. Basic computer skills. Ability to type 40 wpm. Ability to multi‑task. Customer service oriented. Excellent organizational, time management, analytical, and problem‑solving skills. Preferred: Bachelor’s Degree. Additional language skills. Healthcare finance and/or healthcare insurance experience. Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration. Equal Opportunity Northwestern Medicine is an equal‑opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status. Background Check Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case‑by‑case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act. Artificial Intelligence Disclosure Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position; however, all employment decisions will be made by a person. Sign‑on Bonus Eligibility Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign‑on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family. #J-18808-Ljbffr