Financial Clearance Specialist

City/State

New City, New York

Department

Patient Financial Services - Financial Counseling

Bargaining Unit

NH- SEIU-1199

Work Shift

Day

Work Days

MON-FRI

Scheduled Hours

Day

Scheduled Daily Hours

8 HOURS

Hours Per Pay Period

40

Hourly Rate/Range

23.37/ 24.09

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

Job Summary

Under general supervision and in accordance with established policy and procedure, The Financial Clearance Specialist is responsible for coordinating the insurance clearance process by completing Financial Clearance for both scheduled and non-scheduled appointments. Cases needing financial clearance may include (but not limited to) diagnostic testing, surgery, pathology, and lab work verification and clinical trial research. The Financial Clearance Specialist will be responsible for (but not limited to) verifying eligibility, benefits, referral and authorization requirements in addition to obtaining referrals and authorizations as necessary. In addition, the Financial Clearance Specialist will be responsible for researching appointments to ascertain scheduled services as well as identifying the appropriate procedures codes for said services. Financial Clearance will also include financial work-up; financial collection over the phone or asking the patient to pay a specified amount prior to or on the date of service; referring physician and/or patient when applicable. Serves as a liaison between the patient, referring physician and insurance plan to ensure that all services are financially cleared several days in advance to the date of service. The Financial Clearance Specialist will also be responsible for self pay follow-up, assistance to walk-in patients, and provision of payment options (Medicaid, charity care and payment plan) to uninsured patients under general supervision and in accordance with established policy and procedure, is responsible for registration, verification, claim submission, follow-up, cash application, collection of accounts, appropriate referrals and assistance in selection and/or processing payment option assistance through Financial Counseling

Essential Functions

• JOB SPECIFIC COMPETENCIES:

Demonstrates the required job specific technical/professional knowledge, skills and abilities. *

• Collection of financial and demographic data. Interviews, instructs and assists in completion of Medicaid application.
• Monitors all self pay patients, inquiring about coverage, offering options and assistance to realize payment.
• Works with Case Management to expedite insurance related placement issues to reduce length of stay.
• Responds to billing inquiries and resolves problems for walk-in patients and guarantors.
• Maintains follow up on pending Medicaid decisions for timely reclassification and rebilling.
• Maintains and reconciles accounts outsourced to agencies for presumptive Medicaid.
• Performs auditing functions to ensure ongoing registration quality.
• Contacts insurance carriers and confirms authorizations and benefits prior to elective services or within 24 hours of urgent/emergent admissions.
• Minimizes accounts not selected for billing and their impact on revenue cycle. Recognizes and addresses deficiencies.
• Formats collection notes accurately, availing users timely access to pertinent financial information.
• Employee Performance Standards

A. CUSTOMER SERVICE

• Demonstrates the ability to create a positive interaction with the customer.
• Demonstrates positive communication with people of different cultures, values, and beliefs.
• Demonstrates the ability to acknowledge customer concerns and takes corrective action.
• Demonstrates compliance with identified customer service behaviors.
• Provides escort to customers when necessary.
• PERFORMANCE IMPROVEMENT:
• Participates in Department/Hospital-wide activities which improve processes and/or outcomes.
• Utilizes resources to maintain and improve self development and knowledge.
• Complies with licensure and/or certification requirements.
• Participates in annual competency assessment.
• BUDGET:
• Demonstrates fiscally prudent use of equipment and supplies.
• Utilizes charge process for supplies/equipment.
• PROJECTS/ASSIGNMENTS:
• Completes projects/assignments within projected time frames and expectations.
• Qualifications
• High School Required or
• Associate Degree Preferred
• Medical Billing experience required.
• PC knowledge required.
• Bilingual in Spanish preferred
• Ability to perform effectively despite sudden deadlines and changing priorities
• Uses accurate judgment and is able to problem-solve situations utilizing a service excellence focus
• Must have excellent comprehension skills.
• Uses departmental policies, procedures and protocols to evaluate and determine the best alternative for the patient as it pertains to all aspects of Financial Clearance.
• Read and understands requisitions, referrals, insurance forms, patient related data and other forms.
• Reads and understands all screens related to insurance.
• Reads and understands departmental protocols.
• Reads and understands written directions.
• Uses information in protocols to fulfill duties effectively and responsibly.
• Ability to complete simple reports.
• Excellent verbal and written communication skills
• NYSOH Healthcare Exchange Assistor certification preferred (Required within 1st year of employment) Required

Montefiore Nyack Hospital is an equal employment opportunity employer. Montefiore Nyack Hospital will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.