Signature Healthcare is Southeastern Massachusetts’ premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.Position Summary:Financial Clearance Specialist ensures all necessary information is proactively obtained and verified for proper financial reimbursement of services provided while maintaining a positive patient experience. Location: 750 W. Center Street, West Bridgewater, MADepartment: Financial Clearance SpecialistThis is a full-time 40 hour/ week positionResponsibilities:
Accesses work queues and reports and reviews patient accounts to determine financial clearance status of specific patient services.
Takes action on those services without financial clearance.
Ensures demographic and patient contact information is complete and verified with the patient or patient representative.
Verifies the guarantor type and information and ensures it is assigned to the account correctly. This includes personal/family relations, workers compensation insurance, third parties, behavioral health or others as required.
Ensures all possible coverage’s are created and verified, through electronic or manual methods, and all discrepancies are resolved.
Validates that coverage’s are assigned to appropriate visit.
Collects and validates order-related information including office visit, radiology and surgical orders.
Follows up with ordering provider to verify CPT codes.
Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices.
Enters and links referrals and/or authorizations in system.
Processes referrals when necessary, assuring proper tracking and redirection when appropriate.
Using system activities and functions, identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for registration team. Documents account for registrar action.
Analyzes clinical documentation in support of ordered procedure(s) and submits precertification requests through various insurance fax lines, phone systems and web portals.
Follows up on pending accounts and involves ordering provider offices as needed to obtain approvals.
Escalates challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery.
Verifies covered benefits, including remaining hospital days, carve out coverage’s and benefit limits of visit and/or timeframe.
Contacts patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies.
Understands clinical guidelines for payers requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.
Communicates with patients and discusses their financial clearance status when necessary.
Education/Experience/Licenses/Technical/Other:
Education: High school graduate or equivalent
Experience:At least two years prior experience in a health care setting requiring knowledge of insurance coverage, reimbursement, and/or medical terminology and coding. Experience providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data.
Certification/Licensure:
Software/Hardware: Meditech experience preferred.
Other: