Financial Clearance Specialist

GENERAL SUMMARY

The Financial Clearance Specialist works directly with referring physician offices, outpatient services, payers and patients to ensure full detailed audits of patient data and financial responsibilities prior to the provision of care. This role is dedicated to standardized workflows to improve financial outcomes, decrease first pass denials, and increase point of service collections across the CHKD Health System. Reports to the Financial Clearance Manager.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Works with Revenue Cycle departments to identify trends, root causes, and corrective actions; presents outcomes to leadership via monthly meetings, presentations and reports.
• Identifies areas of review and completes monthly audits for all service areas.
• Researches payer websites for payer changes and denials; helps create new processes with leader to close any gaps.
• Ensures goals are met as determined by key performance indicators of volume and accuracy of work completed utilizing system tools or processes.
• Follows established department policies related to patient registration, verification of insurance eligibility and benefits, and referral status; collects patient responsibility amounts for services provided throughout the health system.
• Establishes contact with patients via inbound and outbound calls.
• Secures correct financial information, educates on financial responsibilities, collects estimated amount due and / or advises on financial assistance to pre-register patients for future dates of service.
• Verifies insurance eligibility and benefits utilizing a real-time eligibility tool, payer websites, and / or telephone calls to payers.
• Collects and documents payer verification responses in revenue systems; verifies primary care physician (PCP) and demographic information.
• Secures timely authorizations for all services that require authorization per payer regulations.
• Performs other duties as assigned.

LICENSES AND / OR CERTIFICATIONS

None required.

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS

WORKING CONDITIONS

Normal office environment with little exposure to excessive noise, dust, temperature and the like.

PHYSICAL REQUIREMENTS

Click here to view physical requirements.

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