Catholic Health · 1 month ago
Financial Clearance Center Representative
US-NY-Melville
Full-time
Onsite
Entry Level
1+ years expCatholic Health is one of Long Island’s finest health and human services agencies, focused on providing compassionate care to the community. The Financial Clearance Center Representative is responsible for ensuring patients' visits are financially secured by verifying insurance coverage, obtaining authorizations, and communicating with patients and healthcare staff.
Health Care
Responsibilities
Utilize work queues/work drivers and reports as assigned by management, to complete daily tasks
Confirm that a patient's health insurance(s) is active and covers the patient's procedure; may be completed multiple times before, during, and after a patient's visit/stay
Document a patient's health insurance benefits and coverage for their visit including effective date of the policy, product line, coverage limitations / requirements, and patient liabilities for the type of service(s) provided
Check benefits to determine deductible, coinsurance, and copayment amounts due
Use procedure estimate process/program to notify the patient in advance of the amount due
Make patients aware of financial obligations and appropriately refer them to financial counseling when necessary
Collect co-payments, co-insurance, deductible and self-pay fees prior to or at the point of service. Documents collections in the system and on a daily collection log, and provides patient with receipt
Verify a patient's network status (in or out-of-network) with their plan and communicate to the patient in advance if an out-of-network status applies
Ensure payer requirements including the following are met:
Verify and document insurance eligibility; confirm and document benefits
Notification is made to the insurance carrier for non-scheduled services (Emergency room admissions and observation status)
Review and analyze patient visit information to determine whether authorization is needed and understand payer specific criteria to appropriately secure authorization and clear the account prior to service where possible
Ensure that initial and all subsequent authorizations are obtained in a timely manner and maintained on designated patients
Responsible for reviewing visit data to ensure appropriate and accurate information is provided to the payer to support the authorization request
Utilize analytical, problem solving skills to determine the best course of action to resolve any admission problems created as a result of insurance coverage or prior authorizations
Work closely with various departments to secure prior-approval/authorizations
Ensure financial clearance for unscheduled patients is initiated within 24 hours of admission / arrival
Coordinate with onsite Case Management and Utilization Management to guarantee payer requirements are met for inpatient and 23-hour observation patient
Coordinate with various departments to ensure consistent financial clearance of FCC in-scope services
Foresee and communicate to management team any significant issues/risks
Propose innovative ideas and solutions to enhance operational efficiencies
Maintain knowledge of The Joint Commission and state/federal regulations, laws and guidelines that impact Financial Clearance functions and Patient Access Services
Ensure approval from a patient's insurance(s) is obtained and documented accordingly for tracking purposes. Pre-certification and authorization requirements vary by payer and diagnosis
Validate appropriate demographic, clinical and financial information has been collected to ensure appropriate financial clearance in a timely manner
Complying with Medical Necessity protocols and proper use of Compliance Checker and National Coverage Decisions
Ensure completion of financial clearance functions for all in-scope patients prior to the date of service
Maintain knowledge of payer regulations and hospital charging and collection policies
Stay abreast of changes in Medicare, Medicaid and third-party payer reimbursement requirements
Qualification
Required
Minimum of 1 year of experience in Revenue Cycle Management or Patient Access Services functions
High School Diploma or equivalent experience required
Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology
Work requires the ability to access online insurance eligibility and pre-certification systems
Must have expertise in insurance, managed care and federal/state coverage
Must be customer focused with strong interpersonal skills and courteous with patients, family members, physicians, and staff members
Must be able to discuss and complete financial arrangements on the estimated patient liability under stressful conditions while maintaining positive patient relations
Work requires a high level of problem solving skills
Work requires the ability to interpret and execute policies and procedures
Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents
Must be able to demonstrate a working knowledge of personal computers and other standard office equipment
Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in appearance and approach
Must be able to handle potentially stressful situations and multiple tasks simultaneously
Must be able to successfully complete additional job related training when offered
Preferred
Insurance Verification and Insurance Pre-Certification/Authorization experience preferred
Benefits
Generous benefits packages
Generous tuition assistance
Defined benefit pension plan
A culture that supports professional and educational growth
Company
Catholic Health
When it comes to health care, Long Islanders have a choice.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Sumita Yadav
System Vice President Operations & Cardiovascular Service Line
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