Financial Clearance Specialist

Responsibilities

• Consistently practices Patients First philosophy and adheres to high standards of customer service, fostering a team atmosphere.
• Responds to questions and concerns; forwards, directs and notifies Team Lead or Operations Coordinator of extraordinary issues as necessary.
• Maintains patient confidentiality per HIPAA regulations.
• Provides exceptional customer service to consumers, establishing a positive first impression of Northwestern Medicine.
• Correctly identifies and collects patient demographic information in accordance with organization standards.
• Responds to telephone inquiries and performs appropriate action(s); documents all actions taken in the appropriate software applications.
• Monitors admission/registration and scheduled surgeries flow of patient information through the revenue cycle.
• Serves as a resource to staff and patients for insurance related issues.
• Has a strong understanding of Medicare/Medicaid rules and regulations, and managed care products.
• Is knowledgeable of current contracted and non-contracted healthcare insurance plans.
• Reviews patient electronic medical record for appropriate diagnosis and pre-treatment rendered.
• Has thorough understanding and working knowledge of CPT and ICD-10 coding.
• Consults with physicians and their assistants whenever questions arise to insure timely approvals.
• Follows through and makes corrections in demographics and insurances as they are discovered.
• Monitors Referral In-Basket in EPIC to insure work is consistently completed in a timely manner.
• Facilitates the pre-authorization of diagnostic exams between referring physicians and insurance carriers through online tools, work lists, and direct phone calls.
• Ensures all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared for maximum and timely reimbursement.
• Interacts with various hospital departments and physicians offices to effectively schedule and direct patients through the NMHC systems.
• Performs medical necessity checks as necessary for scheduled services and communicates options to patient if appointment fails.
• Informs patients of any issues with securing the financial account for their encounter and completes out-of-pocket estimations as requested.
• Provides training and education as needed.
• Participates in Quality Assurance reviews to insure integrity of patient data information.
• Uses effective service recovery skills to solve problems or service breakdowns.
• Performs duties within the regulatory guidelines of the Fair Patient Billing Act and the Fair Debt Collection Act.
• Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations.
• Collects authorization numbers in appropriate systems as applicable.
• Demonstrates teamwork by helping co-workers within and across departments.
• Ensures that outpatient procedures have a valid diagnosis code, and that for Medicare patients, medical necessity has been met.
• Contacts patients to notify them of high out-of-pocket liabilities, and to establish/enforce compliance with hospital financial policies.
• Reviews and analyzes all required demographic, insurance/financial and clinical data procured by patient intake and registration areas.
• Verifies eligibility and benefit information using on-line programs.
• Performs pre-certification notification via telephone or electronically and gathers and completes all required documentation for submission to insurance carriers per payor requirements.
• Participates in researching pre-certification denials including missing authorization, patient pre-certification or referral documentation.
• Works on denied accounts with ancillary departments, physician and account representatives to gather required information.
• Utilizes multiple online order retrieval systems to verify or print the patients order.
• Verifies insurance eligibility and benefit levels through the use of online tools (NDAS, ASF, etc.) or over the phone as necessary.
• Completes accurate handoff instructions and notes to scheduling staff by noting appropriately in Epic.
• Proactively prevents issues with patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, and documenting order retrieval.
• Understands minimum data set required for a complete registration, collects and verifies critical data and updates that information into registration system.
• Proactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutions.
• Evaluates procedures and suggests improvements to enhance customer service and operational efficiency.
• Participates in departmental quality improvement activities.
• Monitors registration and scheduling, including insurance verification to insure processing within prescribed quality standards.
• Acts as a training resource for new staff and a resource for coworkers, sharing process and workflow information.

Qualifications

Required: High School Diploma or equivalent. 2-3 years previous 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: Bachelors Degree. Additional language skills. Healthcare finance and/or healthcare insurance experience. Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration.