Financial Clearance Specialist

The Financial Clearance Specialist reflects the mission, vision, and values of NM, adheres to the organization s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. Responsibilities: • Consistently practices Patients First philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphere. • Responds to questions and concerns. • Forwards, directs and notifies Team Lead or Operations Coordinator of extraordinary issues as necessary. • Maintains patient confidentiality per HIPAA regulations. • Provides exceptional customer service to consumers which establish a positive first impression of Northwestern Medicine. • Exceeds all consumer requests and alerts management of issues or concerns that require escalation. • Correctly identifies and collects patient demographic information in accordance with organization standards. • Responds to telephone inquiries and performs appropriate action(s). • Documents all actions taken in the appropriate software applications. • Monitors admission/registration and scheduled surgeries flow of patient information through the revenue cycle. • Serves as a resource to staff and patients for insurance related issues. • Has a strong understanding of Medicare/Medicaid rules and regulations, and managed care products. • Is knowledgeable of current contracted and non-contracted healthcare insurance plans. • Reviews patient electronic medical record for appropriate diagnosis and pre-treatment rendered. • Has thorough understanding and working knowledge of CPT and ICD-10 coding. • Consults with physicians and their assistants whenever questions arise to insure timely approvals. • Follows through and makes corrections in demographics and insurances as they are discovered. • Data entry accuracy is imperative in this position. • Monitors Referral In-Basket in EPIC to insure work is consistently completed in a timely manner. • This involves watching for future test requests to come due and then pre-authorized within the time frame specified by the insurance carrier and the patient notified. • Facilitates the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, through the use of online tools, work lists, and direct phone calls as necessary to ensure maximized patient benefits. • Ensures all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared, to allow for maximum and timely reimbursement to the hospital. • Interacts with various hospital departments and physicians offices to effectively schedule and direct patients through the NMHC systems in a patient/customer friendly manner. • Performs medical necessity checks as necessary for scheduled services, communicates options to patient if appointment fails. • Informs patients of any issues with securing the financial account for their encounter and completes out-of-pocket estimations as requested by patients. • Provides training and education as needed. • Manages work schedule efficiently, completing tasks and assignments on time. • Participates in Quality Assurance reviews to insure integrity of patient data information. • Uses effective service recovery skills to solve problems or service breakdowns when they occur. • Utilizes department and hospital policies and procedures to complete assigned tasks. • Performs duties within the regulatory guidelines of the Fair Patient Billing Act and the Fair Debt Collection Act. • Other duties as assigned. • Communication and Collaboration: • Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations. • Collects authorization numbers in appropriate systems as applicable. • Provides professional and constructive environment for communication across units/departments and resolves operational issues. • May attend intra/interdepartmental meetings which involve walking within NM Campus. • Communicates customer satisfaction issues to appropriate individuals. • Demonstrates teamwork by helping co-workers within and across departments. • Communicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of others. • Ensures that outpatient procedures have a valid diagnosis code, and that for Medicare patients, medical necessity has been met. • Communicates with physician offices to troubleshoot failing medical necessity for Medicare patients. • Contacts patients to notify them of high out-of-pocket liabilities, and to establish/enforce compliance with hospital financial policies. • Reviews and analyzes all required demographic, insurance/financial and clinical data procured by patient intake and registration areas necessary to expedite payment on patient accounts. • Verifies ...