Financial Clearance Specialist (REMOTE)

UMass Memorial Medical Group; Worcester (MA); Remote; USD 29,000 - 40,000; Full time

Job summary

UMass Memorial Medical Group is seeking a Financial Clearance Specialist to verify patient information and collect liabilities prior to services. You will contact insurers, estimate patient liabilities, and process payments in a fast-paced hospital environment.

The role requires strong customer service and billing knowledge, with 4+ years in a healthcare revenue cycle preferred. Work hours are typically 8:00am–4:30pm, in Worcester, MA, with potential signing bonus discussions during interviews.

Qualifications

• Minimum High School Diploma or GED; Associate degree preferred.
• Experience in a healthcare revenue cycle or hospital setting is preferred.

Responsibilities

• Initiates contact with insurance companies to obtain eligibility and gather accurate patient billing information and collect outstanding accounts receivable.
• Accurately estimates patient financial liability (copayments, deductibles, coinsurances, deposits) and explains variables involved.
• Receives and processes patient payments.
• Ensures pre-certification authorization and/or referral is in place prior to service being rendered.
• Directs patients to Financial Counselors or Business Office as needed.
• Reschedules appointments when required due to financial circumstances.

Skills

Billing

Customer service

Healthcare experience

Education

High school diploma or GED

Associate degree preferred

Tools

Hospital billing systems

Job description

Exemption Status

Non-Exempt Hiring Range: $20.94 - $29.27 (based on a full time schedule of 40 hours per week). Please note that the final offer will vary based on scheduled hours. Compensation for part-time or reduced schedules will be prorated based on scheduled weekly hours, experience, skills, qualifications, and internal equity considerations.

Schedule Details: Monday through Friday Scheduled Hours: 8:00am-4:30pm 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) 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.

Responsible for assessing and verifying patient information for scheduled for medical services. This requires verification of patient's demographic, financial and insurance information. Collects co-pays, deductibles, coinsurances, and down payments. Provides estimates for services when appropriate. Receives and processes patient financial liability payments for current and past balances. The focus is to collect patient liabilities prior to service and to resolve any insurance and financial issues prior to services being rendered. Reschedules appointments when appropriate under the guidance of department leader. This position is the front line for customer service, pre-registration and access to care for scheduled services.

I. 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.

II. Position Qualifications

License/Certification/Education

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

Experience/Skills

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

III. Physical Demands and Environmental Conditions

On-the-job time is spent in the following physical activities:

• 1. Stand - 1/3
• 2. Walk - 1/3
• 3