The Financial Clearance Specialist will be responsible for ensuring that all required patient demographic and financial information is obtained, verified, and processed accurately prior to scheduled appointments or procedures. This role will work closely with patients, insurance payors, and healthcare providers to facilitate seamless financial clearance.
Job Description
• Obtain and verify all required patient demographic information for hospital records and billing systems, including name, address, phone number, email address, social security number, referring physician information, and insurance details.
• Process and confirm demographic and insurance data accuracy to ensure smooth patient registration and billing.
• Validate insurance benefits, pre-authorization requirements, and medical necessity for all scheduled procedures and appointments.
• Generate estimates for patients’ out-of-pocket responsibilities and assist in pre-collecting payments where applicable.
• Verify, edit, or remove user-defined referral counts and ensure referrals are in the correct status (e.g., activated, pending, or expired).
• Financially clear accounts for scheduled tests, surgeries, or ambulatory procedures by obtaining necessary authorizations and verifying insurance coverage.
• Obtain and manage referrals for scheduled appointments, ensuring they are obtained within required timelines.
• Edit and finalize the status of referrals, including activating, deactivating, or deferring referrals as needed.
• Monitor and manage referral work queues, deferring or activating referral items as appropriate to ensure timely processing and approval.
• Apply coordination of benefits (COB) and ensure accurate payor details are applied to all accounts.
• Communicate effectively with patients, family members, and referring physicians to inform them about their financial obligations and the status of their insurance coverage and referrals.
• Address inquiries and resolve any financial clearance issues promptly by offering solutions that align with insurance payor requirements.
• Provide patients with information on financial policies, their rights, and any required forms such as Advanced Directives or Privacy Policies.
• Prioritize urgent requests and handle escalated financial clearance issues in accordance with departmental protocols.
• Act as a liaison between patients, insurance payors, and healthcare providers to facilitate prior authorization and financial clearance for scheduled services.
• Collaborate with client personnel, external providers, and insurance companies to resolve patient financial clearance questions or issues effectively and professionally.
• Ensure compliance with all relevant regulations, including HIPAA, FDCPA, and FCRA, and maintain strict confidentiality of patient information.
• Adhere to policies and procedures related to verification of eligibility, benefits, pre-authorization, and financial counseling.
• Participate in ongoing compliance training and maintain awareness of healthcare regulations and industry best practices.
• Perform clerical functions as required, including filing, tracking, and following up with payers for necessary authorizations.
• Attend and participate in team meetings, training sessions, and other departmental activities as needed.
• Support team members and contribute to process improvements and overall team success.
Required Qualifications
• Experience handling insurance verification, obtaining referrals and authorizations, and understanding patient financial responsibilities.
• Proficient in working with commercial and government insurance plans, payer networks, and government resources.
• Strong understanding of medical and insurance terminology.
• Strong customer service skills, including the ability to interpret, evaluate, and resolve basic to complex service issues.
• Attention to detail and accuracy in processing patient information and financial details.
• Strong verbal and written communication skills, including telephone etiquette, interviewing, and interpersonal communication.
• Ability to use critical thinking skills to proactively identify and resolve issues.
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook, etc.).
• Proven ability to handle sensitive information with discretion and ensure compliance with HIPAA regulations.
