Patient Financial Clearance Specialist

Overview

The Financial Clearance Specialist plays a crucial role in ensuring the financial stability of the organization by managing the authorization processes for surgical procedures and patient admissions. This position submits Notices of Admissions (NOA) to payers, secures surgical authorizations, verifies surgical authorizations are on file, and provides patients with accurate cost estimates for services. The Financial Clearance Specialist ensures compliance with the No Surprises Act, helping the organization maintain compliance with federal regulations.

Obtaining timely and accurate authorization information, prior to performing services, reduces claim denials, ensures payer compliance, and establishes better organizational financial outcomes. Patient experience and provider relations are enhanced through the smooth transition of this role’s responsibilities of securing the authorizations and providing accurate estimates. This role is key to maintaining the smooth operation of patient care and experience, while safeguarding timely reimbursements from insurers.

• Request and obtain prior authorizations via the insurance carrier and/or third-party authorization companies and then track the status within CNE’s EHR.
• Evaluate payer policies to understand authorization and notice of admission policies.
• Communicate the request/status of the insurance referral and/or prior authorization with internal referring provider offices/departments via the EHR.
• Complete the notification and insurance verifications for hospital admissions.
• Responsible for ensuring the organization is compliant with the No Surprise Act.
• Review estimates with patients prior to services being rendered.
• Assist patients with applying for CNE Charity care.
• Connect patients with Financial Counselors to be screened for eligibility.
• Communicate the request/status of prior authorization with internal referring provider offices/departments via the EHR.
• Utilize CNE’s EHR to document all work related to obtaining and/or verifying prior authorizations.
• Work with both internal and external referring provider offices/departments to obtain the necessary information to obtain and/or verify the approval of prior authorization.
• Verify the accuracy of the patient’s insurance information to obtain prior authorization.
• Communicate any issues related to obtaining and/or verifying the approval of the prior authorization to management.
• Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients.
• Work and monitor EHR Work Queues (WQ) and in Basket pools through the workday.
• Performs other duties as assigned.

• High School or GED is required;
  Associate degree or Certified/Registered Medical Assistant preferred.
• 5-7 years of experience working in healthcare.
• 3 years of experience submitting notices of admissions and/or prior authorizations and/or pricing estimates.

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement
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External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement
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Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Ethics Statement
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Employee conducts themselves consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.