Revenue Cycle Associate - Financial Clearance
Employment Type: Full Time
Location: Remote
Reports To: Manager, Financial Clearance
You must reside in one of these states to be eligible for this position:
Arkansas California Kentucky
Massachusetts Nevada New Mexico
Oregon Utah Tennessee
Texas Wyoming
Job Summary:
The Revenue Cycle Associate, Financial Clearance position is responsible for ensuring that a patient's visit is financially cleared prior to the date of service. The role includes verifying patient insurance eligibility/benefits, calculating patient liability estimates, securing prior authorization, providing notice of admission, obtaining referrals, and verifying medical necessity. These efforts will result in increased net revenues by reducing front-end related denial write-offs. Interactions will be conducted with providers, payers, patients, and hospital-based personnel. Duties are to be performed accurately and timely while providing exceptional customer service.
Key Responsibilities:
- Ensures Financial Clearance (e.g., verification of eligibility/ benefits, securing prior authorization, etc.) is obtained timely prior to the patient's date of service based on service line and departmental policies.
- Performs coverage discovery using eligibility tools to identify additional insurance coverage if existing insurance on file is inactive.
- Calculates and clearly documents patient liability estimates based on patient's verified benefit information.
- Provides payers with timely inpatient and observation Notices of Admission (NOA) as required based on payer-specific guidelines.
- Validates prior authorization has been obtained and follows up with providers via phone as required for applicable services lines.
- Verifies medical necessity for applicable patients and identifies instances where a Medicare Advance Beneficiary Notices of Noncoverage (ABN or NONC) is required.
- Escalates instances where Financial Clearance may not be obtained (e.g., unable to obtain authorization) prior to patient's DOS to appropriate stakeholders in accordance with departmental deferral policies.
- Resolves insurance coverage and authorization information discrepancies as identified through automated quality assurance tool.
- Works denials related to referral, authorizations, notifications, non-coverage, and medical necessity as assigned. This includes, but is not limited to, coordinating with appropriate stakeholders to submit rebills or appeals and obtaining retro authorization when required.
- Observes privacy, safety, and security procedures, and uses equipment and materials properly.
- Possesses the ability to work within a remote call center environment, free from distractions and background noise.
- Recognizes and consistently exhibits exceptional customer service as a critical factor in all duties performed.
Required Skills & Qualifications:
- Proficient in typing.
- General knowledge of medical terminology.
- Ability to communicate effectively and professionally in English, both verbally and in writing.
- Critical thinking and problem-solving skills.
- High school graduate or equivalent.
- One year of related experience in the medical field is preferred.
Benefits:
- Competitive salary and benefits package.
- Opportunities for professional development and advancement.
- Supportive work environment with a collaborative team.
- Comprehensive healthcare coverage.
- Retirement savings plan.
- Paid time off and flexible scheduling options.
- Student loan repayment program.