Outpatient Financial Clearance Specialist

Beth Israel Lahey Health, Inc.; Exeter; On-site; GBP 21,000 - 29,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Financial Clearance Specialist for Exeter Hospital to complete all financial clearance activities in outpatient services. The role verifies insurance eligibility, determines medical necessity, and obtains authorizations as required, while coordinating with departments and revenue cycle teams.

The position emphasizes accuracy, timely processing of work queues, and adherence to policies.

Qualifications

• High School diploma or GED required.
• Associate's degree preferred.
• 1-3 years related work experience required.
• Knowledge of CPT/HCPCS/ICD-9/ICD-10 and payer policies beneficial.

Responsibilities

• Verifies patient insurance eligibility for visit and contacts payer directly.
• Determines whether medical necessity determination is required and notifies departments of outcomes.
• Obtains payer authorization when needed using payer-specific protocols.
• Escalates issues to revenue cycle peers and stakeholders and documents results.
• Processes assigned work queues and supports reviewing medical necessity for urgent visits.
• Ensures compliance with policies, procedures, and regulatory requirements.
• Identifies trends and reports on operational, productivity, and quality metrics.
• Performs other duties to support the department as needed.

Education

High School diploma or GED

Associate's degree preferred

Tools

Microsoft Office

Job description

Beth Israel Lahey Health is seeking a Financial Clearance Specialist for Exeter Hospital to complete all financial clearance activities in outpatient services. The role verifies insurance eligibility, determines medical necessity, and obtains authorizations as required, while coordinating with departments and revenue cycle teams.

The position emphasizes accuracy, timely processing of work queues, and adherence to policies.