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Brockton Hospital Financial Clearance Specialist in West Bridgewater, Massachusetts

Financial Clearance Specialist

  • 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.

    High school degree or equivalent. 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. Meditech experience preferred.

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