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 is responsible for submitting Notices of Admissions (NOA) to payers, securing surgical authorizations, verifying that authorizations are on file, and providing patients with accurate cost estimates for services. The role ensures compliance with the No Surprises Act and supports timely reimbursements from insurers while enhancing patient experience and provider relations through smooth authorization processes.

• Request and obtain prior authorizations via the insurance carrier and/or third-party authorization companies and track status within CNE’s EHR.
• Evaluate payer policies to understand authorization and notice of admission requirements.
• Communicate the request/status of insurance referrals and/or prior authorizations with internal referring provider offices/departments via the EHR.
• Complete notification and insurance verifications for hospital admissions.
• Ensure organizational compliance with the No Surprises Act.
• Review estimates with patients prior to services being rendered.
• Assist patients with applying for CNE Charity care and connect patients with Financial Counselors to be screened for eligibility.
• Collaborate with internal and external referring provider offices/departments to obtain and verify prior authorization approvals.
• Verify the accuracy of patient insurance information to obtain prior authorization.
• Communicate issues related to obtaining and/or verifying prior authorization to management.
• Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients.
• Monitor EHR queues and in-basket pools throughout the workday.
• Performs other duties as assigned.

• High School or GED 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, Care New England Medical Group, and our Wellness Center) are trusted organizations fueling the latest advances in medical research and patient care.

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

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

Ethics Statement:
Employee conduct aligns with the organization’s ethical standards, including hospital policy, mission, vision, and values.