Financial Clearance Specialist

Financial 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 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, 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.

Qualifications:
Minimum Education
Associate's Degree Health related or business related field. (Required)

Minimum Work Experience
4 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/Knowledge
Superior 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 all Patient Access training assessments required and meet minimum typing requirements.

Functional Accountabilities
Revenue Cycle and Integrity

• Run 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 meeting, 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 organizations financial strength.

• Audit prices estimations to ensure the control and validity process.

• Track monthly clearance volume and outcomes and provide to leadership to support monitoring RIO.

Financial Clearance

• Follow established department policies too 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 Projects

• Based on outcomes and trends provide training and site visit to aid to staff education and productivity.

• Develop training tools and materials accordingly and monitor their use and compliance.

• Build standard processes and 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 Collections

• Interpret 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, include 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 Function

• May perform other duties as assigned.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification

• Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

• Demonstrate collaborative and respectful behavior

• Partner with all team members to achieve goals

• Receptive to others' ideas and opinions

Performance Improvement/Problem-solving

• 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

Cost Management/Financial Responsibility

• Use resources efficiently

• Search for less costly ways of doing things

Safety

• Speak up when team members appear to exhibit unsafe behavior or performance

• Continuously validate and verify information needed for decision making or documentation

• Stop in the face of uncertainty and takes time to resolve the situation

• Demonstrate accurate, clear and timely verbal and written communication

• Actively promote safety for patients, families, visitors and co-workers

• Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance