Financial Clearance Specialist

City of Hope; California; Ibrido; USD 52.000 - 68.000; Tempo pieno

Descrizione del lavoro

City of Hope is seeking a Financial Clearance Specialist in California to pre-register patients, verify insurance information, and obtain authorizations for complex managed care cases. You will interact with patients, payors, and care teams to ensure a smooth patient experience.

The role emphasizes independent judgement, multi-tasking across care areas, and effective communication with physicians and office staff to secure timely authorizations and maintain high-quality service.

Competenze

• Three years related healthcare pre-registration/referral experience required.
• Medical terminology and electronic medical record experience required.
• EPIC EMR experience preferred.

Mansioni

• Identify insurance companies requiring prior authorization and obtain authorization for procedures and testing.
• Coordinate authorizations for providers' services for managed care patients and communicate with payors.
• Perform pre-registration activities including demographic, insurance verification, and service eligibility for scheduled visits.

Conoscenze

Medical terminology

EMR experience

Healthcare pre-registration experience

Formazione

School Diploma or GED

Strumenti

EPIC EMR

Descrizione del lavoro

Position Overview:

This role works under the general direction of a supervisor or manager, responsible for performing pre-registration functions and obtaining authorizations from various insurance carriers. This role requires a high level of independent judgement in order to successfully coordinate and obtain authorization requests for complex managed care patients in a timely and efficient manner. This individual is expected to utilize telecommunications and computer information systems to pre-register patients, verify information and insurance, and obtain authorizations. The Financial Clearance Specialist is best defined as a highly independent and flexible resource that focuses on system-specific service lines that are in alignment with the patient experience initiative. Furthermore, this role must multi-task between different patient care areas to ensure an extraordinary patient experience and that quality standards are met. Additional duties include, but are not limited to physician and patient communication serving as an information resource.

As a successful candidate, you will:

Referral Coordination

• Identifies insurance companies requiring prior authorization for services and obtains authorization. Coordinates authorizations for procedures and testing requested by providers for their managed care patient. Reviews charts on outpatients and reports to third party payors. Retrieves chemo/surgery orders from chart, and requesting authorization through the insurance companies. Prepares all forms required by third party payor for treatment authorization requests. Work on all pending utilization review patients, and achieve authorization for the following day. Getting emergent authorizations from walk-in patients. Verifying with the insurance companies and documents what needs to be pre-certified.


• Educates patient of their insurance policy. Composes letters and memoranda from physician dictation, or verbal direction for submission to insurance companies to obtain authorization or appeal denials. Maintains current records on managed care patients. Keeps Case Managers updated on all BMO and BMT patients.

Pre-Registration

• Performs pre-registration functions prior to the patient appointment (including, but not limited to: obtains and/or verifies demographic, clinical, financial, insurance information, service eligibility, consent forms, and patient/guarantor information for pre-registered accounts).


• Contacts patients, payers, or other departments to confirm and verify insurance and demographic information. Refers patients to financial counselors to resolve insurance or payments issues.


• Identifies and resolves issues by working with patients, payors, and/or other CoH departments and personnel in a single interaction with the patient. Identifies patients with "share of cost" or co-payments by performing pricing estimations, and notifies patients of their expected patient liability and financial responsibility.


• Collects patient/guarantor liabilities and refers patients who are uninsured/underinsured to Financial Counselor for charity, financial assistance or governmental program screening and application processes.


• Notifies CoH contracting department of patients with a non-contracted insurance to prepare a Letter of Agreement (LOA) should patient to pursue services at COH and informs patient of approval status.


• Performs activities required to financial clearance for all patient types. Frequent communications will occur with patients/family members/guarantors, physicians/office staff, medical center and payors.

Your qualifications should include:

• School Diploma or equivalent GED.


• Three years related healthcare pre-registration/referral experience required.


• Medical terminology and electronic medical record experience required.


• Preferably: At least two years front desk oncology practice experience registering patients and scheduling appointments. EPIC EMR experience.

City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.

Please note: City of Hope is committed to a safe and transparent hiring experience. Please be aware that scammers may attempt to impersonate our organization through fake job postings, emails or interviews.