Financial Clearance Specialist

ummh; Worcester (MA); On-site; USD 52,000 - 74,000; Full time

Benefits offered by this job

Signing bonus

Job summary

UMass Memorial Health is seeking a Financial Clearance Specialist to optimize patient billing and eligibility in a busy hospital revenue cycle environment. You will initiate contact with insurance companies, estimate patient financial liability, process payments, and ensure pre-certification or referrals are in place before service.

Strong organizational skills, attention to detail, and experience in healthcare billing are essential.

Qualifications

• Four plus years of experience in a business office or hospital revenue cycle.
• Experience in healthcare environment preferred.
• High school diploma or GED required; associate degree preferred.

Responsibilities

• Initiates contact with insurance companies to obtain eligibility and collect on accounts receivable.
• Estimates patient liability (copays, deductibles, coinsurance) and explains variables.
• Receives and processes patient payments.
• Ensures pre-certification approval or referrals are in place before service.
• Directs patients to Financial Counselors or Business Office as needed.
• Reschedules appointments when required due to financial circumstances.
• Records clear notes on financial clearance status in the system.
• Adheres to Financial Clearance policies in all cases.
• Assesses gaps in coverage to determine patient exposure prior to service.
• Adapts to changing needs and reprioritizes work as necessary.
• Performs other duties to ensure smooth department operation.

Skills

Healthcare revenue cycle experience

Patient billing & collections

Proficiency with hospital computer sys

Strong communication skills

Education

High School Diploma or GED

Associate degree preferred

Tools

Hospital computer systems

Billing software

PCs & Office applications

Job description

Exemption Status

Non-Exempt

Schedule Details

Monday through Friday

Scheduled Hours

8-5

Shift

1 - Day Shift, 8 Hours (United States of America)

Hours

40

Cost Center

99940 - 5478 Financial Clearance

Union

SHARE (State Healthcare and Research Employees)

Signing Bonus

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Major Responsibilities

• 1. Initiates contact with insurance companies to obtain eligibility, gather accurate patient billing information, and performs collections with outstanding accounts receivable.
• 2. Accurately estimates the patient financial liability (copayments, deductibles, coinsurances, deposits, etc. via obtaining accurate demographic and financial information). Answers patient inquiries regarding their liability and able to explain the variables involved.
• 3. Receives and processes patient payments.
• 4. Ensures pre-certification authorization and or referral is in placement prior to service being rendered.
• 5. Appropriately referring patients to Financial Counselors or Business Office dependent on need of patient.
• 6. Reschedules appointments when requested by patient or, under advisement of department leader, when due to financial circumstances appointment requires postponement.
• 7. Enters clear, concise notes concerning financial clearance status in system based on communications.
• 8. Demonstrate knowledge and understanding of all job-related policies and procedures and adheres to and consistently applies the Financial Clearance Policy in all patient cases.
• 9. Assesses gaps in patient coverage to determine patient financial exposure prior to rendering service.
• 10. Consistently demonstrates ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• 11. Performs other duties as assigned, or directed, to ensure smooth operation of the department/unit.

Position Qualifications

License/Certification/Education:

• Preferred:
  1. 1. Minimum High School Diploma, or G.E.D., business concentration preferred.
  2. 2. Associate degree, or higher, preferred.

Experience/Skills:

• Required:
  1. 1. Four plus (4+) years of experience within a business office setting, hospital revenue cycle preferred, Physician office or collection agency.
  2. 2. Prior experience in a healthcare environment required.
• Preferred:
  1. 1. Working knowledge of personal computers and business office applications preferred.
  2. 2. Familiarity with hospital computer systems is a plus.
  3. 3. Knowledge of third party collections and reimbursement preferred.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

Physical Demands and Environmental Conditions

• On-the-job time is spent in the following physical activities:
  1. 1. Stand - 1/3
  2. 2. Walk - 1/3
  3. 3. Sit - 2/3
  4. 4. Talk or hear - 2/3
  5. 5. Uses hands to finger, handle or feel - 2/3
• Weight lifting:
  1. 1. Up to 10 pounds - 1/3

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disabili