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Stamford Health · 3 weeks ago

Financial Clearance Specialist

Stamford, CT

Full-time

Onsite

New Grad, Entry Level

Stamford Health is a healthcare organization seeking a Financial Clearance Specialist to manage insurance authorization and benefits verification processes. The role involves ensuring accurate documentation, maintaining communication with clinical partners, and adhering to productivity standards to facilitate patient services.

Health CareHospitalityNon Profit

H1B Sponsor Likely

Responsibilities

Contacts insurance companies through online portal, phone or fax or to initiate authorization, obtain insurance benefits, eligibility, medical necessity, and / or authorization information

Updates Stamford Health systems with accurate information obtained

Responsible for communicating to service line partners of situations where rescheduling is necessary due to lack of authorization and / or limited benefits and is approved by clinical personnel based on defined service level agreements

Validates scheduled procedures pass medical necessity verification where appropriate and notifies where Advanced Beneficiary Notices (ABNs) must be gathered from patients in advance if the supplied diagnoses information fails

Meets or exceeds productivity standard and audit accuracy goals determined by Revenue Cycle Leadership, meeting timeline standards established by Leadership for all patient services

Ensures integrity of patient accounts by working error reports as requested by Management and/or entering appropriate and accurate data

Proactively ensures that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test / procedure or registration being performed

Confirms all benefits, medical necessity, authorizations, pre-certifications, and financial obligations of patients, are documented on account notes, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts for hand-off to Pre-Service Representatives for estimate completion and patient contact to finish pre-registration

Maintains a close working relationship with clinical partners and/or ancillary departments to ensure continual open communication between clinical, ancillary and all Revenue Cycle departments

May contact physicians or their staff to facilitate the sending of clinical information in support of the authorization to the payor, as assigned

Monitors team mailbox and/or e-mail inbox, faxes, and/or phone calls, responding to all related Financial Clearance account issues, within defined time frames

Exhibits effective time management skills and maintains flexibility by being available for all partners and team

May assists team with reports and projects to maintain team and individual productivity standards and goals

In working patient accounts for benefits, monitors accounts for change in insurance status prior to registration and sends updates to appropriate areas for follow up

In working patient accounts for pre-certification, contacts physicians or their staff, schedulers, and clinical service area where appropriate, notifying authorization is not obtained by department deadline, advising of visit cancellation, reschedule, or to obtain life or limb / urgent / emergent order from physician allowing patient to proceed in accordance with defined service level agreements

Contacts patient to notify when visit is rescheduled

Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime

Maintains sign-on access to online tools to provide consistent service to patients, clinical partners, schedulers, and Front-End Revenue Cycle Operations team members

Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account

Responsible for financial clearance on multiple service areas (Surgery, Inpatient, Cardiology, etc.) depending on operational needs

Other duties as assigned

Qualification

Prior authorization experienceManaged care experienceMicrosoft Office proficiencyBasic math skillsEffective communicationDiscretion in confidentialitySelf-motivatedAdaptability

Required

Prior experience obtaining prior authorization / pre-certification for scheduled services is required

Experience with managed care payers is required

Ability to use discretion when discussing personnel/patient related issues that are confidential in nature

Responsive to ever-changing matrix of hospital needs and acts accordingly

Self-motivator, quick thinker

Capable of communicating professionally and effectively in English, both verbally and in writing

High School diploma or GED

Proficient in Microsoft Office Programs such as Outlook, Word, and Excel

Proficient in performance of basic math functions

Preferred

Associate degree and/or higher-level education or completed coursework preferred

Company

Stamford Health

Stamford Health is a not-for-profit healthcare organization.

Founded in 1896

Stamford, Connecticut, USA

1001-5000 employees

https://www.stamfordhealth.org/

H1B Sponsorship

Stamford Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (3)

2022 (2)

2021 (6)

2020 (3)