Financial Clearance Specialist

South Shore Health System; Massachusetts; On-site; USD 36,000 - 48,000; Full time

Job summary

South Shore Health System in Norwell, MA, is seeking a Patient Access professional for full-time work in SSH Patient Access. The role involves pre-certification, eligibility and verification of benefits, and co-pay collection, with emphasis on accuracy and patient communication.

Meditech, PICIS, Passport, and Tracker are used for daily tasks. The position requires teamwork, strong insurance knowledge, excellent customer service, and careful documentation.

Qualifications

• Medical terminology knowledge for accurate coding and communication.
• Strong knowledge of third party insurance required.
• Experience with hospital revenue cycle processes is a plus.

Responsibilities

• Register patients and perform pre-certification and eligibility verification.
• Determine benefits, co-pays, and notify patients; arrange collections.
• Write and follow up on appeals for denials.
• Explain estimates for self-pay and non-covered services.
• Document actions clearly in accounts and collaborate with case management.

Skills

Medical terminology

Insurance knowledge

Computer skills

Third party insurance

Attention to detail

Customer service

Teamwork

Organizational skills

Tools

Meditech

PICIS

Passport

Tracker

Job description

Requisition Number: R-23353 Facility: LOC0027 - 141 Longwater Norwell141 Longwater Drive Norwell, MA 02061 Department Name: SSH Patient Access Status: Full time Budgeted Hours: 40 Shift: Day (United States of America) Under the direction of the Manager of Patient Access Services. Responsible for all pre-certification,eligibility , verification of benefits and collection of eligible co-pays

Compensation Pay Range: $17.42 - $23.45

Essential Functions

1. Responsible for registration, pre-certification, eligibility , verification of benefits and co-pay determination on all accounts
   • a. Insures that account is processed with less than 5 denials per year.
   • b. Determination of copay and notify patient and arrange for collection
   • c. Complies with all regulatory agencies.( newborn notification) 100% of the time
   • d. Keeps current with all internal and external policies and procedures which may affect reimbursement.
   • e. Ability to write and follow up on appeals for denials.
   • f. Ability to give patients estimate for self-pay and non-covered services.
   • g. Document clearly on account all actions and transactions
   • h. Able to collaborate with case management for patient care
   • i. Able to defer elective cases based on credit and collections policy
   • j. Manage level of care changes to ensure proper reimbursement
2. Technology – Embraces technological solutions to work processes and practices.
   • a. Able to function using department computer programs. Meditech,PICIS,PAssport and web based programs, and run reports.
   • b. Able to use and update PICIS, Tracker and Passport programs.
   • c. Manage own API(timecard) system.
   • d. Able to utilize the telephone system,including VERA
   • e. Understands process for computer downtime
   • f. Understands and promotes credit and collection policy
   • g. Able to assign and trascribe ICD-9 and CPT codes
   • h. Manage and utilize insurance web sites to ensure appropriate notification and referrals are done
3. Safety Awareness – Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment.
   • a. Adheres to patient identification policies/procedures.
   • b. Adheres to universal precautions and respiratory etiquette guidelines.
   • c. Understands individual role/responsibility during hospital codes(e.g. Code Green, Code red).
   • d. Do safety rounds
   • e. NIMS 100 completed
   • f. Understand role in department specific plan for emergency preparedness
   • g. Able to identify correct subscriber Essential Functions (Cont.) I. Technology and Learning

Essential Functions (Cont.) I. Technology and Learning

• a. Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.
• b. Embraces technological advances that allow us to communicate information effectively and efficiently based on role.

Unit Department Specific Job Functions

Unit Specific functions are those tasks, duties and responsibilities that are specific to the performance of the job within a certain unit(s).

Following are unit specific functions of the job, along with the corresponding performance standards.

1. Can register patients meeting the department standard of 98% accuracy rate.

Non-essential functions

Non-essential functions are those tasks, duties and responsibilities that are not critical to the performance of the job.

Following are non-essential functions of the job, along with the corresponding performance standards.

1. Other duties as required.

Medical terminology. Insurance Knowledge Computer skills Strong knowledge of third party insurance required Ability to follow through and troubleshoot Attention to detail Customer Service skills Organizational skills Ability to work well within a team.

Monday through Friday 8:00-4:30 Responsibilities if Required: Education if Required:

License/Registration/Certification Requirements:

South Shore Health is a not-for-profit, charitable health system offering primary and specialty care, hospital care, home health and community care, emergency and urgent care, and preventative and wellness services. We are the largest independent health system in southeastern Massachusetts. South Shore Health brings together like-minded people who work “As One” toward a common goal of providing exceptional care the people of our region deserve. We unite top-caliber talent, technology, and service with the wishes and personal needs of patients and their families to develop individualized treatment plans.