Financial Clearance Specialist - Signature Healthcare
West Bridgewater, MA 02379
About the Job
Signature Healthcare is Southeastern Massachusetts’ premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.
Position Summary:
Financial Clearance Specialist ensures all necessary information is proactively obtained and verified for proper financial reimbursement of services provided while maintaining a positive patient experience.
Location: 750 W. Center Street, West Bridgewater, MA
Department: Financial Clearance Specialist
This is a full-time 40 hour/ week position
Responsibilities:
- Accesses work queues and reports and reviews patient accounts to determine financial clearance status of specific patient services.
- Takes action on those services without financial clearance.
- Ensures demographic and patient contact information is complete and verified with the patient or patient representative.
- Verifies the guarantor type and information and ensures it is assigned to the account correctly. This includes personal/family relations, workers compensation insurance, third parties, behavioral health or others as required.
- Ensures all possible coverage’s are created and verified, through electronic or manual methods, and all discrepancies are resolved.
- Validates that coverage’s are assigned to appropriate visit.
- Collects and validates order-related information including office visit, radiology and surgical orders.
- Follows up with ordering provider to verify CPT codes.
- Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices.
- Enters and links referrals and/or authorizations in system.
- Processes referrals when necessary, assuring proper tracking and redirection when appropriate.
- Using system activities and functions, identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for registration team. Documents account for registrar action.
- Analyzes clinical documentation in support of ordered procedure(s) and submits precertification requests through various insurance fax lines, phone systems and web portals.
- Follows up on pending accounts and involves ordering provider offices as needed to obtain approvals.
- Escalates challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery.
- Verifies covered benefits, including remaining hospital days, carve out coverage’s and benefit limits of visit and/or timeframe.
- Contacts patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies.
- Understands clinical guidelines for payers requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.
- Communicates with patients and discusses their financial clearance status when necessary.
Education/Experience/Licenses/Technical/Other:
PI251058719