Financial Clearance Specialist

Signature Healthcare, MA; West Bridgewater (MA); On-site; USD 45,000 - 65,000; Full time

Job summary

Signature Healthcare in West Bridgewater, MA is seeking a Financial Clearance Specialist to ensure accurate financial clearance for services and a positive patient experience.

The role focuses on verifying demographic, insurance, and authorization details, coordinating with providers, and processing referrals and precertifications to support timely patient care. Strong attention to detail and customer service are essential.

Qualifications

• High school diploma or equivalent required.
• At least 2 years in healthcare, insurance coverage knowledge preferred.
• Experience with patient data collection and verification.
• Familiarity with Meditech is a plus.

Responsibilities

• Accesses work queues and reviews patient accounts to determine financial clearance status.
• Takes action on services without financial clearance.
• Verifies demographic and patient contact information with the patient or representative.
• Verifies guarantor type and information and assigns correctly (including relations, workers comp, third parties).
• Ensures all coverages are created and verified and discrepancies resolved.
• Validates coverage(s) are assigned to the appropriate visit.
• Collects and verifies order-related information including visits and procedures.
• Follows up with ordering provider to verify CPT codes.
• Verifies PCP information and referrals in place for the provider and service.
• Enters and links referrals and/or authorizations in system.
• Processes referrals when necessary and tracks/redirects appropriately.
• Identifies non-covered services and prepares ABN/waiver for registrar action.

Skills

Customer service

Communication

Attention to detail

Teamwork

Education

High school diploma or equivalent

Tools

Meditech

Job description

Signature Healthcare is Southwestern Massachusetts' premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.

Position Summary

Financial Clearance Specialist ensures all necessary information is proactively obtained and verified for proper financial reimbursement of services provided while maintaining a positive patient experience.

Location: 750 W. Center Street, West Bridgewater, MA

Department: Financial Clearance Specialist

This is a full-time 40 hour/ week position

Responsibilities

• Accesses work queues and reports and reviews patient accounts to determine financial clearance status of specific patient services.
• Takes action on those services without financial clearance.
• Ensures demographic and patient contact information is complete and verified with the patient or patient representative.
• Verifies the guarantor type and information and ensures it is assigned to the account correctly. This includes personal/family relations, workers compensation insurance, third parties, behavioral health or others as required.
• Ensures all possible coverage's are created and verified, through electronic or manual methods, and all discrepancies are resolved.
• Validates that coverage's are assigned to appropriate visit.
• Collects and validates order-related information including office visit, radiology and surgical orders.
• Follows up with ordering provider to verify CPT codes.
• Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices.
• Enters and links referrals and/or authorizations in system.
• Processes referrals when necessary, assuring proper tracking and redirection when appropriate.
• Using system activities and functions, identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for registration team. Documents account for registrar action.
• Analyzes clinical documentation in support of ordered procedure(s) and submits precertification requests through various insurance fax lines, phone systems and web portals.
• Follows up on pending accounts and involves ordering provider offices as needed to obtain approvals.
• Escalates challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery.
• Verifies covered benefits, including remaining hospital days, carve out coverage's and benefit limits of visit and/or timeframe.
• Contacts patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies.
• Understands clinical guidelines for payers requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.
• Communicates with patients and discusses their financial clearance status when necessary.

Education/Experience/Licenses/Technical/Other

• Education: High school graduate or equivalent
• Experience:At least two years prior experience in a health care setting requiring knowledge of insurance coverage, reimbursement, and/or medical terminology and coding. Experience providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data.
• Certification/Licensure:
• Software/Hardware: Meditech experience preferred.
• Other: