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Financial Clearance Authorization Specialist

Company: St. Catherine of Siena
Location: Melville
Posted on: September 21, 2022

Job Description:

Financial Clearance Authorization Specialist

Facility: CHS Services Location: Melville, NY Department: Financial Clearance Center PA Category: Administrative / Business Support Schedule: Full Time Shift: Day shift Hours: 9-5 ReqNum: 6044955

Position Summary:

The Financial Clearance Senior Authorization Specialist is a highly skilled and productive individual 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 not only performs insurance verification, insurance notification and authorization, patient financial responsibility communication, and other patient access operational activities but also serves as a technical resource for the Financial Clearance department of the Catholic Health Services of Long Island (CHSLI).

The Financial Clearance Senior Authorization Specialist will update patient insurance coverage, send notification to payers for non-scheduled admissions, and ensure pre-certification/authorization requirements are complete prior to the date of service. The role will work closely with Utilization Management, Patient Accounts, and other key stakeholders in the revenue cycle to ensure all pertinent patient and insurance information is on file for clinical submission and billing.


* Utilize workdrivers and reports, as assigned by management, to ensure completion of financial clearance functions for all in-scope patients.
* Confirm and document the patient's health insurance(s) effective dates, network status, service coverage requirements, and patient liabilities including deductible, coinsurance and co-payment amounts. This may be completed multiple times before, during, and after a patient's visit/stay.
* For scheduled services, review and analyze patient visit information to determine whether authorization is needed and utilize payer specific procedures to appropriately secure authorization in order to clear the account prior to service where possible.
* Works with denials reports to identify ways to prevent future denials and improve the authorization and, ultimately, claim payment success rates.
* For non-scheduled services such as inpatient admissions, observation care, maternal care, and emergency surgeries and procedures, notify the patient's insurance within 24 hours of admission or date of service, coordinate with Case Management and Utilization Management for insurance requirUse financial estimate process to make patients aware of estimated financial responsibility, collect and document receipt of estimated patient responsibility amounts prior to service, and appropriately refer them to financial counseling when necessary.
* Demonstrates the highest level of technical skill, efficiency, production, and quality in the department and proactively collaborates with the staff level individuals to help them improve in these areas.
* Utilize problem solving skills to determine the best course of action to resolve any problems created as a result of insurance coverage or prior authorizations.
* 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.
* Comply with Medical Necessity protocols and proper use of Compliance Checker and National and Local Coverage Decisions.
* Maintain knowledge of Medicare, Medicaid and third-party payer regulations and hospital charging and collection policies.
* Responsible for other duties as assigned.

Position Requirements and Qualifications:

* High School Diploma or equivalent experience required
* Minimum experience of 8 years in Revenue Cycle Management or Patient Access Services functions. Insurance Verification and Insurance Pre-Certification/Authorization experience required.
* Knowledge or Abilities critical to this role:
* 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.

Keywords: St. Catherine of Siena, New Haven , Financial Clearance Authorization Specialist, Accounting, Auditing , Melville, Connecticut

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