Financial Clearance Specialist

Northwestern Medicine; Chicago (IL); On-site; USD 61,073,000 - 79,285,000; Full time

Benefits offered by this job

Tuition Reimbursement

Student Loan Repayment

Professional Development

Wellbeing Fund

Matching 401(k)

Paid time off

Job summary

Northwestern Medicine is seeking a Financial Clearance Specialist in Chicago, IL. This role ensures financial clearance for procedures, verifies patient eligibility, and coordinates with physicians and payors to maximize reimbursement.

The position requires hospital billing experience, strong communication, and proficiency with data entry and CPT/ICD-10 knowledge. It offers full-time hours, daytime shifts, and comprehensive benefits.

Qualifications

• High School Diploma or equivalent required.
• 2-3 years hospital billing, insurance follow-up, or customer service in a hospital setting preferred.
• Excellent interpersonal, verbal, and written communication skills.
• Proficiency in computer data-entry/typing; attention to accuracy.
• Ability to read, write, and communicate effectively in English.
• Basic computer skills; ability to type 40 wpm.
• Ability to multi-task and manage time efficiently.
• Customer service oriented with strong organizational skills.
• Experience with insurance eligibility and CPT/ICD-10 knowledge is a plus.

Responsibilities

• Assist patients with questions and concerns to provide exceptional service.
• Ensure patient demographics and insurance information are accurate.
• Perform pre-certifications, pre-authorizations, and eligibility checks as needed.
• Maintain confidentiality and HIPAA compliance at all times.
• Document actions in the appropriate systems and monitor revenue cycle steps.
• Coordinate with physicians, staff, and insurance payors to ensure timely approvals.
• Support scheduling and registration processes to maximize reimbursement.
• Participate in quality improvement and training activities.

Skills

Customer service

Verbal communication

Written communication

Typing 40 wpm

Data entry

Multitasking

English proficiency

Analytical skills

Time management

Organizational skills

Education

High School Diploma or equivalent

Bachelor's degree

Tools

Epic

NDAS

ASF

Job description

Financial Clearance Specialist

Location: Chicago, Illinois

Business Unit: Northwestern Medicine Corporate

Job Requisition ID: 222427

Job Function: Customer Service

Shift: Day Job (1st)

Type of Employment: Full-Time

Salary: $21.29 - $27.67 (Hourly Rate)

Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement.

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits(opens in new window) section located at jobs.nm.org/benefits to learn more.

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you’ll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you’ve been, and we support where you’re headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional, and financial well-being.

Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)
• $10,000 Student Loan Repayment ($5,000 part-time)
• $1,000 Professional Development per year ($500 part-time)
• $250 Wellbeing Fund per year ($125 for part-time)
• Matching 401(k)
• Excellent medical, dental and vision coverage
• Life insurance
• Annual Employee Salary Increase and Incentive Bonus
• Paid time off and Holiday pay

Description

The Financial Clearance Specialist reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities

• Consistently practices Patients First philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphere.
• Responds to questions and concerns.
• Forwards, directs and notifies Team Lead or Operations Coordinator of extraordinary issues as necessary.
• Maintains patient confidentiality per HIPAA regulations.
• Provides exceptional customer service to consumers which establish a positive first impression of Northwestern Medicine.
• Exceeds all consumer requests and alerts management of issues or concerns that require escalation.
• Correctly identifies and collects patient demographic information in accordance with organization standards.
• Responds to telephone inquiries and performs appropriate action(s).
• Documents all actions taken in the appropriate software applications.
• Monitors admission/registration and scheduled surgeries flow of patient information through the revenue cycle.
• Serves as a resource to staff and patients for insurance related issues.
• Has a strong understanding of Medicare/Medicaid rules and regulations, and managed care products.
• Is knowledgeable of current contracted and non-contracted healthcare insurance plans.
• Reviews patient electronic medical record for appropriate diagnosis and pre-treatment rendered.
• Has thorough understanding and working knowledge of CPT and ICD-10 coding.
• Consults with physicians and their assistants whenever questions arise to insure timely approvals.
• Follows through and makes corrections in demographics and insurances as they are discovered.
• Data entry accuracy is imperative in this position.
• Monitors Referral In-Basket in EPIC to insure work is consistently completed in a timely manner.
• This involves watching for future test requests to come due and then pre-authorized within the time frame specified by the insurance carrier and the patient notified.
• Facilitates the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, through the use of online tools, work lists, and direct phone calls as necessary to ensure maximized patient benefits.
• Ensures all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared, to allow for maximum and timely reimbursement to the hospital.
• Interacts with various hospital departments and physicians offices to effectively schedule and direct patients through the NMHC systems in a patient/customer friendly manner.
• Performs medical necessity checks as necessary for scheduled services, communicates options to patient if appointment fails.
• Informs patients of any issues with securing the financial account for their encounter and completes out-of-pocket estimations as requested by patients.
• Provides training and education as needed.
• Manages work schedule efficiently, completing tasks and assignments on time.
• Participates in Quality Assurance reviews to insure integrity of patient data information.
• Uses effective service recovery skills to solve problems or service breakdowns when they occur.
• Utilizes department and hospital policies and procedures to complete assigned tasks.
• Performs duties within the regulatory guidelines of the Fair Patient Billing Act and the Fair Debt Collection Act.
• Other duties as assigned.

Communication and Collaboration

• Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations.
• Collects authorization numbers in appropriate systems as applicable.
• Provides professional and constructive environment for communication across units/departments and resolves operational issues.
• May attend intra/interdepartmental meetings which involve walking within NM Campus.
• Communicates customer satisfaction issues to appropriate individuals.
• Demonstrates teamwork by helping co-workers within and across departments.
• Communicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of others.
• Ensures that outpatient procedures have a valid diagnosis code, and that for Medicare patients, medical necessity has been met.
• Communicates with physician offices to troubleshoot failing medical necessity for Medicare patients.
• Contacts patients to notify them of high out-of-pocket liabilities, and to establish/enforce compliance with hospital financial policies.
• Reviews and analyzes all required demographic, insurance/financial and clinical data procured by patient intake and registration areas necessary to expedite payment on patient accounts.
• Verifies eligibility and benefit information using on-line programs.
• Performs pre-certification notification via telephone or electronically and gathers and completes all required documentation for submission to insurance carriers per payor requirements.
• Participate in researching pre-certification denials including missing authorization, patient pre-certification or referral documentation.
• Works on denied accounts with ancillary departments, physician and account representatives to gather required information.
• Cross-training between various departments may take place to insure coverage.

Technology

• Utilizes multiple online order retrieval systems to verify or print the patients order.
• Verifies insurance eligibility and benefit levels through the use of online tools (NDAS, ASF, etc.) or over the phone as necessary.
• Completes accurate handoff instructions and notes to scheduling staff, by noting appropriately in Epic.
• Demonstrates ability to use all computer applications efficiently and to the capacity needed in this position.

Efficiency, Process Improvement, and Business Growth

• Proactive in preventing issues with patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, communicating relevant information and documenting order retrieval in notes for check-in person.
• Understands minimum data set required for a complete registration, collects and verifies critical data and updates that information into registration system.
• Understands departmental and individual quality metrics.
• Proactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutions.
• Evaluates procedures and suggests improvements to enhance customer service and operational efficiency.
• Participates in departmental quality improvement activities.
• Provides ideas and suggestions for process improvements within the department.
• Monitors registration and scheduling, including insurance verification to insure processing within prescribed quality standards.
• Adjusts processes as needed to meet standards.
• Uses organizational and unit/department resources efficiently.
• Acts as a training resource for new staff and a resource for coworkers, sharing process and workflow information.

Qualifications

Required

• High School Diploma or equivalent.
• 2-3 years previous hospital billing, insurance follow-up, or customer service in a hospital setting.
• Excellent interpersonal, verbal, and written communication skills.
• Proficiency in computer data-entry/typing.
• Excellent verbal and written communication skills.
• Ability to read, write, and communicate effectively in English.
• Basic computer skills.
• Ability to type 40 wpm.
• Ability to multi-task.
• Customer service oriented.
• Excellent organizational, time management, analytical, and problem solving skills.

Preferred

• Bachelors Degree.
• Additional language skills.
• Healthcare finance and/or healthcare insurance experience.
• Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration.

AA/EOE