Patient Financial Clearance Specialist

Job Summary

The Financial Clearance Specialist plays a crucial role in ensuring the financial stability of the organization by managing the authorization processes for surgical procedures and patient admissions. This position is responsible for submitting Notices of Admissions (NOA) to payers, securing surgical authorizations, verifying surgical authorizations are on file, and providing patients with accurate cost estimates for services. The Financial Clearance Specialist ensures compliance with the No Surprises Act, helping the organization maintain compliance with federal regulations. Obtaining timely and accurate authorization information, prior to performing services, reduces claim denials, ensures payer compliance, and establishes better organizational financial outcomes. Patient experience and provider relations are enhanced through the smooth transition of this roles responsibilities of securing the authorizations and providing accurate estimates. This role is key to maintaining the smooth operation of patient care and experience, while safeguarding timely reimbursements from insurers.

Duties & Responsibilities

• Request and obtain prior authorizations via the insurance carrier and/or third-party authorization companies and then track the status within CNE's EHR.
• Evaluate payer polices to understand authorization and notice of admission policies.
• Communicate the request/status of the insurance referral and/or prior authorization with internal referring provider offices/departments via the EHR.
• Complete the notification and insurance verifications for hospital admissions.
• Responsible for ensuring the organization is compliant with the No Surprise Act
• Review estimates with patients prior to services being rendered.
• Assist patients with applying for CNE Charity care.
• Connect patients with Financial Counselors to be screened for eligibility.
• Communicate the request/status of prior authorization with internal referring provider offices/departments via the EHR.
• Utilize CNE's EHR to document all work related to obtaining and/or verifying prior authorizations.\
• Work with both internal and external referring provider offices/departments to obtain the necessary information to obtain and/or verify the approval of prior authorization.
• Verify the accuracy of the patient's insurance information to obtain prior authorization.
• Communicate any issues related to obtaining and/or verifying the approval of the prior authorization to management.
• Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients.
• Work and monitor EHR WQ's and in Basket pools through the workday.
• Performs other duties as assigned

Requirements

• High School or GED is required.

• Associate degree or Certified/Registered Medical Assistance preferred.

• 5-7 years of experience working in healthcare

• 3 years of experience submitting notice of admissions and/or prior authorizations and/or pricing estimates

• Ability to communicate with people of various diverse backgrounds in a sensitive and compassionate way.

• Knowledge of federal regulations related to the No Surprises Act and healthcare billing compliance.

• Must have excellent presentation, communication, organizational and customer service skills.

• Strong understanding of payer requirements, authorization processes, insurance, and medical terminology.

• Possesses specialized level of knowledge and thorough understanding of the systems/applications and subjects listed below:

• Microsoft 365 (formerly Microsoft Office)

• EHRs, specifically EPIC

• HIPAA

• Always puts patients' needs first and ensures that quality and safety requirements are met.

• Possesses strong listening, communication (written and verbal) and people skills to positively interact with patients, and staff at all levels of the organization.

• Strong problem-solving skills with the ability to troubleshoot and resolve issues.

About Us

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation's top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.

EEO Statements

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.