<p>The Financial Clearance Specialist is responsible for the financial clearance of services performed at Stamford Health. The responsibility includes obtaining benefits, medical necessity validation, initiating authorizations, and/or pre-certifications according to the actual test / procedure or registration being performed. Reviews the functions of referral management, scheduling, and registration and monitors the accuracy in in actual test/procedure being order/performed. Manages insurance portal access to support the financial clearance process. Collaborates and communicates with providers, insurance representatives, patients, and various departments at Stamford Health on scheduled and/or unscheduled accounts. Meets or exceeds department audit accuracy and productivity standard goal. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Adheres to Stamford Health's Corporate Compliance Plan and to all rules and regulations of all applicable local, state, and federal agencies and accrediting bodies. The Financial Clearance Specialist, under general supervision, maintains performance standards appropriate to areas for all scheduled and/or unscheduled patient accounts under responsibility. Meets timeline standards established by Leadership for all patient services.</p> <p>Key Responsibilities:</p> <ul> <li>Contacts insurance companies through online portal, phone or fax or to initiate authorization, obtain insurance benefits, eligibility, medical necessity, and / or authorization information. Updates Stamford Health systems with accurate information obtained. Responsible for communicating to service line partners of situations where rescheduling is necessary due to lack of authorization and / or limited benefits and is approved by clinical personnel based on defined service level agreements. </li><li>Validates scheduled procedures pass medical necessity verification where appropriate and notifies where Advanced Beneficiary Notices (ABNs) must be gathered from patients in advance if the supplied diagnoses information fails. </li><li>Meets or exceeds productivity standard and audit accuracy goals determined by Revenue Cycle Leadership, meeting timeline standards established by Leadership for all patient services. Ensures integrity of patient accounts by working error reports as requested by Management and/or entering appropriate and accurate data. </li><li>Proactively ensures that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test / procedure or registration being performed. Confirms all benefits, medical necessity, authorizations, pre-certifications, and financial obligations of patients, are documented on account notes, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts for hand-off to Pre-Service Representatives for estimate completion and patient contact to finish pre-registration. </li><li>Maintains a close working relationship with clinical partners and/or ancillary departments to ensure continual open communication between clinical, ancillary and all Revenue Cycle departments. May contact physicians or their staff to facilitate the sending of clinical information in support of the authorization to the payor, as assigned. </li><li>Monitors team mailbox and/or e-mail inbox, faxes, and/or phone calls, responding to all related Financial Clearance account issues, within defined time frames. Exhibits effective time management skills and maintains flexibility by being available for all partners and team. May assists team with reports and projects to maintain team and individual productivity standards and goals. </li><li>In working patient accounts for benefits, monitors accounts for change in insurance status prior to registration and sends updates to appropriate areas for follow up. In working patient accounts for pre-certification, contacts physicians or their staff, schedulers, and clinical service area where appropriate, notifying authorization is not obtained by department deadline, advising of visit cancellation, reschedule, or to obtain life or limb / urgent / emergent order from physician allowing patient to proceed in accordance with defined service level agreements. Contacts patient to notify when visit is rescheduled. </li><li>Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime. Maintains sign-on access to online tools to provide consistent service to patients, clinical partners, schedulers, and Front-End Revenue Cycle Operations team members. </li><li>Assists with the training of others on the process of financial clearance </li><li>Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account </li></ul> <p>The above statements reflect the general duties and responsibilities necessary to describe the principal functions of the job, as identified, and shall not be considered an exhaustive list of job responsibilities which may be inherent in the job. Responsibilities are subject to change.</p> <p>QUALIFICATIONS/REQUIREMENTS:</p> <ul> <li>Ability to use discretion when discussing personnel/patient related issues that are confidential in nature </li><li>Responsive to ever-changing matrix of hospital needs and acts accordingly </li><li>Self-motivator, quick thinker </li><li>Capable of communicating professionally and effectively in English, both verbally and in writing </li><li>Detail oriented with the ability to define, document, and analyze potential improvements to the core process of prior authorization, medical necessity, verification, and pre-registration. </li><li>Knowledge of healthcare industry best practices for patient financial communication. </li><li>Sound understanding of Medicare, Medicaid, Other Government, Managed Care and Commercial, Third-Party Liability (TPL) payer plans as well as knowledge of medical terminology and standard coding convention, prior authorization requirements, and coverage limitations. </li><li>Knowledge of Anatomy & Physiology </li><li>Understanding of Medicare Advance Beneficiary Notices (ABNs), commercial payer portals and third-party authorization sites. </li><li>Ability to communicate changes in payer or federal regulatory guidelines in a timely and professional manner </li></ul> <p>EXPERIENCE: 1 year experience in Patient Financial Services, Patient Access, Customer Service, or related area (registration, finance, collections, customer service, medical office, or contract management). Prior experience obtaining prior authorization / pre-certification for scheduled services preferred. Experience with managed care payers a plus.</p> <p>EDUCATION: High School diploma or GED. Associate degree and/or higher-level education or completed coursework preferred.</p>