Financial Clearance Specialist

Financial Clearance Specialist

Signature Healthcare is Southeastern Massachusetts' premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be : medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.

Position Summary : Financial Clearance Specialist ensures all necessary information is proactively obtained and verified for proper financial reimbursement of services provided while maintaining a positive patient experience.

Location : 750 W. Center Street, West Bridgewater, MA

This is a full-time 40 hour / week position

Responsibilities :

• 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.

Education / Experience / Licenses / Technical / Other :

Education : High school graduate or equivalent

Experience : 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.

Certification / Licensure :

Software / Hardware : Meditech experience preferred.

Other :