Children's National Medical Center
Financial Clearance Specialist
Children's National Medical Center, Silver Spring, Maryland, United States, 20900
Job Description - Financial Clearance Specialist (240002DD)DescriptionFinancial Clearance Specialists are members of the Patient Access team dedicated to completing patient access workflows related to improve financial outcomes to decrease first pass denials and increase point of service collections across CNHS. Financial Clearance Specialists use quality auditing and reporting tools to identify denial issues and trends by staff member, clinical area, payer, and provider. Financial Clearance Specialists work directly with referring physician offices, payers, and patients to ensure full detailed audits of patient's data capture and financial responsibilities prior to the provision of care. Based on outcomes, they will work directly with Business Operations, Managed Care, and other departments on identified process improvements. Financial Clearance Specialists will write appeals for authorization denials as required. In addition, they will complete monthly audits and presentations to provide timely feedback to servicing areas leadership to obtain desired outcomes. Financial Clearance Specialists will provide training and education to managers and staff to obtain sustainable improvements in areas of opportunity.QualificationsMinimum EducationAssociate's Degree in Health related or business related field. (Required)
Minimum Work Experience4 years Healthcare experience in Business Operations, Patient Access, and Revenue Cycle. Prior auditing experience and root cause analysis. Proficient in Microsoft office products. (Required)
Required Skills/KnowledgeSuperior customer service skills and professional etiquette. Strong verbal, interpersonal, and telephone skills. Experience in healthcare setting and computer knowledge necessary. Attention to detail and ability to multi-task in complex situations. Demonstrated ability to solve problems independently or as part of a team. Knowledge of and compliance with confidentiality guidelines and CNMC policies and procedures. Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers. Previous experience with Cerner, Passport, or other related software programs and EMRs preferred. Bilingual abilities preferred. Successful completion of all Patient Access training assessments required and meet minimum typing requirements.Functional AccountabilitiesRevenue Cycle and IntegrityRun and identify areas of review and complete monthly audits and all service areas.Complete data deep dives and identify trends, root causes, corrective actions, and present outcomes to leadership via monthly meetings, presentations, and reports.Audit authorization performance by registration staff across the enterprise and communicate findings to the appropriate department leaders; collaborate with individual departments - Compliance Department, Patient Financial Services, Case Management, and Centers of Excellence to reduce first pass denials.Review all claim denials for authorizations to identify trends, root causes, corrective actions, and appeal options. Write appeal letters to payers to obtain payment for services. Based on outcomes, complete claims recovery with payors and business operations to increase the organization's financial strength.Audit price estimations to ensure the control and validity process.Track monthly clearance volume and outcomes and provide to leadership to support monitoring RIO.Financial ClearanceFollow established department policies to completely and accurately pre-register patients, verify insurance eligibility and benefits, validate pre-certification or referral status, and collect patient responsibility amounts for services provided throughout the health system meeting departmental standards for productivity and quality.Establish contact with patients via inbound and outbound calls and access department work queues to pre-register patients for future dates of service.Verify insurance eligibility and benefits by utilizing integrated real-time eligibility tool, payer websites, and telephone calls to payers; document payer verification responses in designated fields within the registration pathway; compare the primary care physician (PCP) information indicated by the insurance verification response to the location of the primary care office visit, if applicable; contact the patient/family and provide guidance for resolution of PCP discrepancies or mismatches.Validate authorization status, if applicable, and communicate with ordering physicians’ offices to obtain authorization information; document authorization status in designated field within the registration pathway.Work collaboratively with all departments/services of the Children’s National Medical Center to ensure that all scheduled patients have undergone financial clearance prior to service.Staff Developments and Special ProjectsBased on outcomes and trends provide training and site visit to aid staff education and productivity.Develop training tools and materials accordingly and monitor their use and compliance.Build standard processes to increase TOS collections and decrease first pass denials.Participate and take lead on special projects that impact revenue cycle.Research revenue cycle related outcomes to support business decisions.Pre-Service / Point of Service CollectionsInterpret insurance verification information to estimate patient financial responsibility amounts for scheduled services and inpatient stays.Analyze insurance plan benefit information and utilize price estimation technology to calculate patient responsibility amounts for scheduled services and inpatient stays, including co-insurance and deductibles.Communicate patient financial responsibility amounts and initiate the point of service (POS) collections process.Identify patients requiring payment assistance options and facilitate communication between patients and CNMC Financial Information Center (FIC).Provide data to departments in an effort to increase TOS collections.Review eligibility system usage compliance and communicate outcomes accordingly.Non-Essential FunctionMay perform other duties as assigned.Organizational AccountabilitiesAnticipate and respond to customer needs; follow up until needs are met.Demonstrate collaborative and respectful behavior.Partner with all team members to achieve goals.Receptive to others’ ideas and opinions.Contribute to a positive work environment.Demonstrate flexibility and willingness to change.Identify opportunities to improve clinical and administrative processes.Make appropriate decisions, using sound judgment.Use resources efficiently.Search for less costly ways of doing things.
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Minimum Work Experience4 years Healthcare experience in Business Operations, Patient Access, and Revenue Cycle. Prior auditing experience and root cause analysis. Proficient in Microsoft office products. (Required)
Required Skills/KnowledgeSuperior customer service skills and professional etiquette. Strong verbal, interpersonal, and telephone skills. Experience in healthcare setting and computer knowledge necessary. Attention to detail and ability to multi-task in complex situations. Demonstrated ability to solve problems independently or as part of a team. Knowledge of and compliance with confidentiality guidelines and CNMC policies and procedures. Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers. Previous experience with Cerner, Passport, or other related software programs and EMRs preferred. Bilingual abilities preferred. Successful completion of all Patient Access training assessments required and meet minimum typing requirements.Functional AccountabilitiesRevenue Cycle and IntegrityRun and identify areas of review and complete monthly audits and all service areas.Complete data deep dives and identify trends, root causes, corrective actions, and present outcomes to leadership via monthly meetings, presentations, and reports.Audit authorization performance by registration staff across the enterprise and communicate findings to the appropriate department leaders; collaborate with individual departments - Compliance Department, Patient Financial Services, Case Management, and Centers of Excellence to reduce first pass denials.Review all claim denials for authorizations to identify trends, root causes, corrective actions, and appeal options. Write appeal letters to payers to obtain payment for services. Based on outcomes, complete claims recovery with payors and business operations to increase the organization's financial strength.Audit price estimations to ensure the control and validity process.Track monthly clearance volume and outcomes and provide to leadership to support monitoring RIO.Financial ClearanceFollow established department policies to completely and accurately pre-register patients, verify insurance eligibility and benefits, validate pre-certification or referral status, and collect patient responsibility amounts for services provided throughout the health system meeting departmental standards for productivity and quality.Establish contact with patients via inbound and outbound calls and access department work queues to pre-register patients for future dates of service.Verify insurance eligibility and benefits by utilizing integrated real-time eligibility tool, payer websites, and telephone calls to payers; document payer verification responses in designated fields within the registration pathway; compare the primary care physician (PCP) information indicated by the insurance verification response to the location of the primary care office visit, if applicable; contact the patient/family and provide guidance for resolution of PCP discrepancies or mismatches.Validate authorization status, if applicable, and communicate with ordering physicians’ offices to obtain authorization information; document authorization status in designated field within the registration pathway.Work collaboratively with all departments/services of the Children’s National Medical Center to ensure that all scheduled patients have undergone financial clearance prior to service.Staff Developments and Special ProjectsBased on outcomes and trends provide training and site visit to aid staff education and productivity.Develop training tools and materials accordingly and monitor their use and compliance.Build standard processes to increase TOS collections and decrease first pass denials.Participate and take lead on special projects that impact revenue cycle.Research revenue cycle related outcomes to support business decisions.Pre-Service / Point of Service CollectionsInterpret insurance verification information to estimate patient financial responsibility amounts for scheduled services and inpatient stays.Analyze insurance plan benefit information and utilize price estimation technology to calculate patient responsibility amounts for scheduled services and inpatient stays, including co-insurance and deductibles.Communicate patient financial responsibility amounts and initiate the point of service (POS) collections process.Identify patients requiring payment assistance options and facilitate communication between patients and CNMC Financial Information Center (FIC).Provide data to departments in an effort to increase TOS collections.Review eligibility system usage compliance and communicate outcomes accordingly.Non-Essential FunctionMay perform other duties as assigned.Organizational AccountabilitiesAnticipate and respond to customer needs; follow up until needs are met.Demonstrate collaborative and respectful behavior.Partner with all team members to achieve goals.Receptive to others’ ideas and opinions.Contribute to a positive work environment.Demonstrate flexibility and willingness to change.Identify opportunities to improve clinical and administrative processes.Make appropriate decisions, using sound judgment.Use resources efficiently.Search for less costly ways of doing things.
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