Financial Clearance Center Representative - Catholic Health

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

The Financial Clearance Representative works with the various components of the insurance verification, insurance notification and authorization, and financial clearance operational activities for the Catholic Health (CH) for defined acute care and outpatient hospital services.

Responsibilities include working in conjunction with Patient Access Services to facilitate on-site patient communication. The role is responsible for ensuring a patient's visit is financially secured which requires communication with patients, physicians, office staff, clinicians and insurance companies to obtain and accurately record patient demographic and insurance information. The role also includes the process of verifying patient insurance coverage, notification to payers for non-scheduled admissions, and pre-certification/authorization requirements via phone or through an online system to secure authorizations for scheduled procedures requiring an authorization, prior to the date of service.

Responsibilities:

• Utilize work queues/work drivers and reports as assigned by management, to complete daily tasks.
• Confirm that a patient's health insurance(s) is active and covers the patient's procedure; may be completed multiple times before, during, and after a patient's visit/stay.
• Document a patient's health insurance benefits and coverage for their visit including effective date of the policy, product line, coverage limitations / requirements, and patient liabilities for the type of service(s) provided.
• Check benefits to determine deductible, coinsurance, and copayment amounts due.
• Use procedure estimate process/program to notify the patient in advance of the amount due.
• Make patients aware of financial obligations and appropriately refer them to financial counseling when necessary.
• Collect co-payments, co-insurance, deductible and self-pay fees prior to or at the point of service. Documents collections in the system and on a daily collection log, and provides patient with receipt.
• Verify a patient's network status (in or out-of-network) with their plan and communicate to the patient in advance if an out-of-network status applies.
• Ensure payer requirements including the following are met:
• Verify and document insurance eligibility; confirm and document benefits
• Notification is made to the insurance carrier for non-scheduled services (Emergency room admissions and observation status)
• Review and analyze patient visit information to determine whether authorization is needed and understand payer specific criteria to appropriately secure authorization and clear the account prior to service where possible.
• Ensure that initial and all subsequent authorizations are obtained in a timely manner and maintained on designated patients.
• Responsible for reviewing visit data to ensure appropriate and accurate information is provided to the payer to support the authorization request.
• Utilize analytical, problem solving skills to determine the best course of action to resolve any admission problems created as a result of insurance coverage or prior authorizations.
• Work closely with various departments to secure prior-approval/authorizations
• Ensure financial clearance for unscheduled patients is initiated within 24 hours of admission / arrival.
• Coordinate with onsite Case Management and Utilization Management to guarantee payer requirements are met for inpatient and 23-hour observation patient.
• Coordinate with various departments to ensure consistent financial clearance of FCC in-scope services.
• Foresee and communicate to management team any significant issues/risks.
• Propose innovative ideas and solutions to enhance operational efficiencies.
• Maintain knowledge of The Joint Commission and state/federal regulations, laws and guidelines that impact Financial Clearance functions and Patient Access Services.
• Ensure approval from a patient's insurance(s) is obtained and documented accordingly for tracking purposes. Pre-certification and authorization requirements vary by payer and diagnosis.
• Validate appropriate demographic, clinical and financial information has been collected to ensure appropriate financial clearance in a timely manner.
• Complying with Medical Necessity protocols and proper use of Compliance Checker and National Coverage Decisions.
• Ensure completion of financial clearance functions for all in-scope patients prior to the date of service.
• Maintain knowledge of payer regulations and hospital charging and collection policies.
• Stay abreast of changes in Medicare, Medicaid and third-party payer reimbursement requirements.

Requirements:

• Minimum of 1 years of experience in Revenue Cycle Management or Patient Access Services functions.
• Insurance Verification and Insurance Pre-Certification/Authorization experience preferred.
• High School Diploma or equivalent experience required
• Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology.
• Work requires the ability to access online insurance eligibility and pre- certification systems.
• Must have expertise in insurance, managed care and federal/ state coverage.
• Must be customer focused with strong interpersonal skills and courteous with patients, family members, physicians, and staff members.
• Must be able to discuss and complete financial arrangements on the estimated patient liability under stressful conditions while maintaining positive patient relations.
• Work requires a high level of problem solving skills
• Work requires the ability to interpret and execute policies and procedures.
• Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents.
• Must be able to demonstrate a working knowledge of personal computers and other standard office equipment
• Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in appearance and approach.
• Must be able to handle potentially stressful situations and multiple tasks simultaneously.
• Must be able to successfully complete additional job related training when offered.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.