(Archived) Financial Clearance Specialist West Bridgewater, MA

Searching for a full-time Financial Clearance Specialist with at least two years prior experience in a health care setting requiring knowledge of insurance coverage, reimbursement, and/or medical terminology and coding. Accesses work queues and reports and reviews patient accounts to determine financial clearance status of specific patient services. Takes action on those services without financial clearance. Ensures demographic and patient contact information is complete and verified with the patient or patient representative. Verifies the guarantor type and information and ensures it is assigned to the account correctly. This includes personal/family relations, workers compensation insurance, third parties, behavioral health or others as required. Ensures all possible coverage’s are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validates that coverage’s are assigned to appropriate visit. Collects and validates order-related information including office visit, radiology and surgical orders. Follows up with ordering provider to verify CPT codes. Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices. Enters and links referrals and/or authorizations in system. Processes referrals when necessary, assuring proper tracking and redirection when appropriate. Using system activities and functions, identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for registration team. Documents account for registrar action. Analyzes clinical documentation in support of ordered procedure(s) and submits precertification requests through various insurance fax lines, phone systems and web portals. Follows up on pending accounts and involves ordering provider offices as needed to obtain approvals. Escalates challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery. Verifies covered benefits, including remaining hospital days, carve out coverage’s and benefit limits of visit and/or timeframe. Contacts patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies. Understands clinical guidelines for payers requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes. Communicates with patients and discusses their financial clearance status when necessary.

Requirements:

• High school degree or equivalent.
• At least two years prior experience in a health care setting requiring knowledge of insurance coverage, reimbursement, and/or medical terminology and coding.
• Experience providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data.
• Meditech experience preferred.