Financ Clearance Specialist I

Location: Winchester, MA
Job ID: 169714-1A
Date Posted: Sep 23, 2021
Category: Specialist

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Job Description

Welcome To

Welcome to Winchester Hospital, part of Beth Israel Lahey Health. Winchester Hospital was the first hospital in Massachusetts to earn Magnet recognition, the American Nurses Association’s highest honor for nursing excellence, three times. It has since received the recognition a fourth time. As the northwest suburban Boston area’s leading provider of comprehensive health care services, the 229-bed facility provides care in general, bariatric and vascular surgery, orthopedics, pediatrics, cardiology, pulmonary medicine, oncology, gastroenterology, rehabilitation, radiation oncology, pain management, obstetrics/gynecology and a Level IIB Special Care Nursery.

 

About the Job

JOB SUMMARY:       

Contribute to the Hospital’s mission by ensuring that all information necessary for proper financial reimbursement for patient care is collected and verified prior to the patient’s date of service. Collaborate with insurance companies when necessary to proactively validate benefits, eligibility and referral requirements.  Communicates with patients to assure they understand their payment obligations and steps necessary to meet these obligations, while maintaining a positive patient experience.

 

QUALIFICATIONS:

Education

Required:  High School Diploma or equivalent

Preferred: 

Experience

Required:  Prior experience in a business/health care setting required.  Knowledge of insurance coverage and/or reimbursement required.  Experience providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data.

Preferred:

Other Skills/Knowledge

Required:

·        Able to work successfully in a fast-paced, multi-task environment, where some independent decision making is necessary.  Able to process electronic information and data accurately and efficiently.

·        For safety and quality reasons, must be able to read, write and communicate effectively in English with patients, visitors and fellow members of the hospital team.

Preferred:

 

LICENSES, REGISTRATIONS, CERTIFICATIONS:

Required:   None

Preferred:

                                    

LIFE SUPPORT CERTIFICATION REQUIRED: Not applicable 

POPULATION SPECIFIC REQUIREMENTS: Not applicable

 

OTHER JOB REQUIREMENTS:

Professional Commitment Requirements:  Keep abreast of developments in the field and/or licensure through continuing education, participation in professional organizations or a combination of both.

On-call Requirement:  No

Schedule Requirements:  Hours of work may be subject to change based upon the needs of the business/department

Travel Requirements:  Travel to off-sites and other hospital locations based upon the needs of the business/department

 

REPORTING RELATIONSHIPS:

·        Reports to the Patient Access Financial Clearance Supervisor

·        Not responsible for supervising the work of others. 

SECTION 4: JOB FUNCTIONS

Consistent with the PROMISE principles and inherent in a hospital environment, employees must be flexible in meeting patients’ and the Hospital’s needs. While the list below describes the primary functions of this job, all employees at Winchester Hospital need to recognize that an essential element of their job is the ability to respond to unanticipated and/or changing situations.  This may result in assuming responsibilities or tasks, which are not on this list.

 

As part of the Patient Access team, this position:

·         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 coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved.  Validates that coverages are assigned to appropriate visit.

·         Collects and validates visit-related registration information including MSPQ, occurrence codes, and attending and referring providers.

·         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 in system.

·         Processes referrals when necessary, assuring proper tracking and redirection when appropriate.  Understands each clinical department’s referral certification protocols and ensure referrals are certified at the appropriate level.

·         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.

·         Assists with precertification process when required.

·         Verifies covered benefits, including remaining hospital days, carve out coverages and benefit limits of visit and/or timeframe.

·         Contacts patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies,

·         Communicates with patients and discusses their financial clearance status when necessary. Explains the status of any services not financially cleared and advises patients of the proper resolution steps, including self-payment. Directs patients to Lahey Financial Counselors when appropriate.

·         Works with the Financial Counselors, clinical departments, outside providers, third party insurers and any other individual or entity to assist in resolving patient  financial clearance questions or problems in the most effective and positive manner possible.

·        Researches claim edits and payment denials related to financial clearance and works closely with the Lahey Patient Financial Services staff to resolve these denials. Communicates resolution to patients.

 

 

SECTION 5: DEPARTMENT SPECIFIC JOB FUNCTIONS 

·         Demonstrate an understanding of the job description, performance expectations, and annual competency assessment(s).

·         Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.

·         Participate in departmental and/or interdepartmental quality improvement activities. 

·         Participate in and successfully completes Mandatory Education.

·        Perform all other duties as needed or directed to meet the needs of the department.

 

Shift

40 hours

About Us

Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve.  Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health.  Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.