Financial Clearance & Eligibility Specialist

Beth-Israel-Lahey-Health; Exeter (NH); On-site; USD 29,000 - 39,000; Full time

Job summary

Beth Israel Lahey Health is hiring for a financial clearance specialist in Exeter, NH. The role focuses on verifying insurance eligibility and determining medical necessity for outpatient services, ensuring authorization when required and escalating issues efficiently.

The candidate will coordinate with departments and revenue cycle teams, maintain records, and support timely workflows while adhering to policies and compliance standards.

Qualifications

• High School diploma or GED required.
• Associate's degree preferred.
• 1–3 years related work experience required.
• Working knowledge of CPT, HCPCS, ICD-9/ICD-10.

Responsibilities

• Verifies patient's insurance eligibility for visit using online tools and by contacting payer.
• Identifies payer medical necessity determinations before services are rendered.
• Determines authorization requirements and obtains payer authorization when needed.
• Identifies and escalates issues for resolution with revenue cycle peers and clinical stakeholders.
• Completes assigned work queues and reports daily to meet productivity and quality standards.
• Follows BIDMC policies to ensure compliance with requirements.
• Identifies trends and provides periodic reports on metrics.
• Performs other duties to support the department.

Skills

Microsoft Office

Education

High School diploma or GED

Associate's degree preferred

Tools

CPT/HCPCS/ICD-9/ICD-10 knowledge

Job description

Beth Israel Lahey Health is hiring for a financial clearance specialist in Exeter, NH. The role focuses on verifying insurance eligibility and determining medical necessity for outpatient services, ensuring authorization when required and escalating issues efficiently.

The candidate will coordinate with departments and revenue cycle teams, maintain records, and support timely workflows while adhering to policies and compliance standards.