Financial Clearance Specialist

Performs pre-registration functions prior to the patient appointment (including, but not limited to: obtains and/or verifies demographic, clinical, financial, insurance information, service eligibility, consent forms, and patient/guarantor information for pre-registered accounts). Performs other departmental duties as assigned, such as answering and making phone calls, managing incoming/outgoing faxes, organizing and filing departmental documents, inventorying supplies, data entry, etc.

Our client, a Cancer Center company, is looking for a Financial Clearance Specialist for their Irwindale, CA location.
 
Responsibilities:

• Under the general direction of a supervisor or manager, responsible for performing pre-registration functions and obtaining authorizations from various insurance carriers.
• This role requires a high level of independent judgement in order to successfully coordinate and obtain  authorization requests for complex managed care patients in a timely and efficient manner.
• This individual is expected to utilize telecommunications and computer information systems to pre-register patients, verify information and insurance, and obtain authorizations.
• The Financial Clearance Specialist is best defined as a highly independent and flexible resource that focuses on system-specific service lines that are in alignment with the patient experience initiative.
• Furthermore, this role must multi-task between different patient care areas to ensure an extraordinary patient experience and that quality standards are met.
• Additional duties include, but are not limited to physician and patient communication serving as an information resource.
• Referral Coordination:
• Identifies insurance companies requiring prior authorization for services and obtains authorization.
• Coordinates authorizations for procedures and testing requested by providers for their managed care patient.
• Reviews charts on outpatients and reports to third party payors.
• Retrieves chemo/surgery orders from chart, and requesting authorization through the insurance companies.
• Prepares all forms required by third party payor for treatment authorization requests.
• Work on all pending utilization review patients, and achieve authorization for the following day.
• Getting emergent authorizations from walk-in patients.
• Verifying with the insurance companies and documents what needs to be pre-certified.
• Educates patient of their insurance policy.
• Composes letters and memoranda from physician dictation, or verbal direction for submission to insurance companies to obtain authorization or appeal denials.
• Maintains current records on managed care patients.
• Keeps Case Managers updated on all BMO and BMT patients.
• Pre-Registration
• Performs pre-registration functions prior to the patient appointment (including, but not limited to: obtains and/or verifies demographic, clinical, financial, insurance information, service eligibility, consent forms, and patient/guarantor information for pre-registered accounts).
• Contacts patients, payers, or other departments to confirm and verify insurance and demographic information.
• Refers patients to financial counselors to resolve insurance or payments issues.
• Identifies and resolves issues by working with patients, payors, and/or other client departments and personnel in a single interaction with the patient. Identifies patients with “share of cost” or co-payments by performing pricing estimations,
• and notifies patients of their expected patient liability and financial responsibility.
• Collects patient/guarantor liabilities and refers patients who are uninsured/underinsured to Financial Counselor for charity, financial assistance or governmental program screening and application processes.
• Notifies client contracting department of patients with a non-contracted insurance to prepare a Letter of Agreement (LOA) should patient to pursue services at client and informs patient of approval status.
• Performs activities required to financial clearance for all patient types.
• Frequent communications will occur with patients/family members/guarantors, physicians/office staff, medical center and payors.
• Customer Service:
• Ensure a high level of customer service by greeting, being a resource to patients and visitors. Serve as a liaison between patients and support staff. Develop effective relationships with colleague, physicians, providers, leaders and other
• employees across the organization. Demonstrates genuine interest in helping our patients, providers and other employees by using excellent communication skills, being polite, friendly, patient and calm under pressure.  Managing multiple, changing priorities in an effective and organized manger, under stressful demand while maintaining exceptional service. Maintain composure when dealing with difficult situations and responding professionally. Independently recognize a high priority situation, taking appropriate and immediate action. Effectively communicates with service delivery and other departments to resolve issues that impact patient care and escalating issues that cannot be resolved in accordance
• with departmental guidelines. Answering daily phone calls and pages from doctors, patients, employees and insurance companies.
• Quality Assurance:
• Maintains appropriate level of productivity and accuracy for work performed based on department standards. Maintains thorough knowledge of policies, procedures, and standard work within the department in order to successfully performance duties on a day-to-day basis.
• Miscellaneous Duties:
• Performs other departmental duties as assigned, such as answering and making phone calls, managing incoming/outgoing faxes, organizing and filing departmental documents, inventorying supplies, data entry, etc.
• Follows established client and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan.  Practices a high level of integrity and honesty in maintaining confidentiality. Performs other related duties as assigned or requested.

 
Requirements:

• Recent experience with Epic EMR
• Strong background in submitting and reviewing authorizations in a cancer hospital
• Experience in insurance and benefit verification
• Experience working with major insurance plan web portals
• Proficiency in Microsoft Teams, Outlook, Excel, and Adobe Acrobat Pro
• Examines and assesses clients' finance numbers and situations, and helps clients reduce and eliminate their debt through a debt management program and plan and save for retirement.
• Gathers clients' budget information, financial obligations, and goals.
• Detects and analyzes clients' financial problems and needs, submits summaries, and reports documenting research and analyses.
• Recommends and counsels client on financial options or solutions, using their knowledge of consumer debt, consumer loans, types of interest, investments, tax laws, and insurance.5-10 years of experience
• Minimum Education: High School Diploma
• Minimum Experience: Three years related healthcare pre-registration/referral experience required.  Medical terminology and electronic medical record experience required.
• Preferred Courses/Training: EPIC EMR
• Preferred Experience: At least two years front desk oncology practice experience registering patients and scheduling appointments.
• Ability to recognize and use medical terminology Excellent oral/written communication, interpersonal, collaborative, analytical and organizational skills.
• Bilingual preferred.
• Demonstrated ability to effectively use online systems.
• Function with minimal supervision with high level of productivity
• Foster and promote a positive and professional image
• Must be able to foster and maintain sound working relationships.
• Independently motivated and driven to achieve high goals
• Effective use of telecommunications and electronic medical record systems
• Seek continuous improvement in knowledge and skills
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner, under stressful demands while maintaining exceptional service.
• Demonstrated ability to maintain composure when confronted by difficult situations and to respond professionally.
• Maintains commitment to our extraordinary patient care standards and guidelines
• Interpersonal/human relations skills.
• Strong knowledge of PC, phone systems and technology.
• Readily accepts work assignments and changes in a positive manner.
• Skill in recognizing an emergency or high priority situation, taking appropriate and immediate action.
• Software: Microsoft Word and Outlook
• EMRs – Allscripts, Touchworks and EPIC
• Telecommunications – Avaya phone system
• Customer Relationship Management - Salesforce
• Machines/Equipment:
• Personal computer/peripheral equipment
• Telephone
• Fax
• Photocopier
• Working / Environmental Conditions: Contact with patients/patient families under varied circumstances
• Exposed to material of a confidential nature on a regular basis
• Occasional pressure due to multiple calls and inquiries
• Occasionally covers varied shifts, weekends and holidays
• Pressure due to deadline requirements
• Subject to many interruptions
• Atmosphere and environment associated with outpatient care areas

 
Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

Why Should You Apply?

• Health Benefits
• Referral Program