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Description:
GENERAL SUMMARY
The Financial Clearance Specialist is the pre-service contact for patients whose role is to obtain all necessary information to register and financially clear patients before the service date. This role directly impacts the patient's experience by serving as the customer service point of contact pre-service. The Financial Clearance Specialist will be responsible for pre-registration, insurance verification, price estimation, and pre-service patient liability collections.
ESSENTIAL JOB FUNCTION/COMPETENCIES
Responsibilities include but are not limited to:
Verifies the patient’s insurance using RTE (Real Time Eligibility) or by contacting the payer directly via the payer’s website or phone call.
Verifies negative batch or RTE responses by contacting the payer directly via the payer website or phone call.
Obtains accurate and complete information regarding patient benefits, coverage, and eligibility including effective date, coverage limits and in-network status, and out-of-pocket patient amounts.
Notifies and collects patient deposit requirements and financial obligations in advance of rendering services.
Works exceptions to resolve outstanding eligibility issues including contacting patient to capture accurate insurance information prior to appointment.
Collaborates with the Financial Counseling team, understands state policies, and works to improve the ability to correctly identify true self-pay patients or those patients in need of financial counseling
Follows appropriate escalation procedures related to financial clearance not obtained with cross functional teams, including Front Desk, Providers, Administration, etc.
Performs other position related duties as assigned.
KNOWLEDGE | SKILLS | ABILITIES
Demonstrates understanding of business and how actions contribute to company performance.
Proven familiarity with eligibility and financial clearance activities.
Demonstrates excellent customer service skills.
Extensive knowledge of practice management system, Microsoft Office, and other tools as it relates to financial clearance.
Excellent time management skills and ability to handle multiple tasks while meeting departmental deadlines.
Professional verbal and written communication skills.
Well organized with the ability to maintain accuracy and confidentiality.
Knowledge of medical terminology, healthcare coding systems, and clinics functions.
Excellent verbal and written communication skills.
Excellent organizational skills and attention to detail.
Strong analytical and problem-solving skills.
Skill in using computer programs and applications including Microsoft Office.
Ability to work independently and manage deadlines.
Complies with HIPAA regulations for patient confidentiality.
Complies with all health and safety policies of the organization
Requirements:
EDUCATION REQUIREMENTS
High School Diploma or equivalent required.
EXPERIENCE REQUIREMENTS
2+ years’ experience within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling, financial clearance and/or customer service activities.
Comprehensive understanding of insurance verification, contract benefits, and medical terminology.
GENERAL SUMMARY
The Financial Clearance Specialist is the pre-service contact for patients whose role is to obtain all necessary information to register and financially clear patients before the service date. This role directly impacts the patient's experience by serving as the customer service point of contact pre-service. The Financial Clearance Specialist will be responsible for pre-registration, insurance verification, price estimation, and pre-service patient liability collections.
ESSENTIAL JOB FUNCTION/COMPETENCIES
Responsibilities include but are not limited to:
Verifies the patient’s insurance using RTE (Real Time Eligibility) or by contacting the payer directly via the payer’s website or phone call.
Verifies negative batch or RTE responses by contacting the payer directly via the payer website or phone call.
Obtains accurate and complete information regarding patient benefits, coverage, and eligibility including effective date, coverage limits and in-network status, and out-of-pocket patient amounts.
Notifies and collects patient deposit requirements and financial obligations in advance of rendering services.
Works exceptions to resolve outstanding eligibility issues including contacting patient to capture accurate insurance information prior to appointment.
Collaborates with the Financial Counseling team, understands state policies, and works to improve the ability to correctly identify true self-pay patients or those patients in need of financial counseling
Follows appropriate escalation procedures related to financial clearance not obtained with cross functional teams, including Front Desk, Providers, Administration, etc.
Performs other position related duties as assigned.
KNOWLEDGE | SKILLS | ABILITIES
Demonstrates understanding of business and how actions contribute to company performance.
Proven familiarity with eligibility and financial clearance activities.
Demonstrates excellent customer service skills.
Extensive knowledge of practice management system, Microsoft Office, and other tools as it relates to financial clearance.
Excellent time management skills and ability to handle multiple tasks while meeting departmental deadlines.
Professional verbal and written communication skills.
Well organized with the ability to maintain accuracy and confidentiality.
Knowledge of medical terminology, healthcare coding systems, and clinics functions.
Excellent verbal and written communication skills.
Excellent organizational skills and attention to detail.
Strong analytical and problem-solving skills.
Skill in using computer programs and applications including Microsoft Office.
Ability to work independently and manage deadlines.
Complies with HIPAA regulations for patient confidentiality.
Complies with all health and safety policies of the organization
Requirements:
EDUCATION REQUIREMENTS
High School Diploma or equivalent required.
EXPERIENCE REQUIREMENTS
2+ years’ experience within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling, financial clearance and/or customer service activities.
Comprehensive understanding of insurance verification, contract benefits, and medical terminology.
