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Beth Israel Lahey Health · 2 weeks ago

Financial Clearance Specialist - Beverly

Beverly, MA

Full-time

Onsite

Entry Level

$20.50/hr - $27.59/hr

1+ years exp

Beth Israel Lahey Health is a growing healthcare organization dedicated to making a difference in people’s lives. The Financial Clearance Specialist is responsible for completing all financial clearance activities for outpatient services, ensuring medical necessity and authorization requirements are met, while providing feedback to departments on these processes.

Elder CareHealth CareHospitalPrimary and Urgent CareProfessional ServicesTraining

Responsibilities

Verifies patient's insurance eligibility for visit, using various online tools and by contacting the payer directly. (essential)

Identifies payer medical necessity determination before services are rendered. Informs departments of failed instances. When circumstances dictate, requests additional information to re-run medical necessity check. (essential)

Determines authorization requirement and, when necessary, obtains authorization from payer by utilizing payer specific protocols. Requests and coordinates any additional information from departments when needed. (essential)

Identifies and escalates issues timely and appropriately for resolution and communicates and coordinates with revenue cycle peers, leadership and clinical stakeholders. Documents interim and final results in appropriate systems. (essential)

Completes assigned work queues and reports daily to achieve standards of productivity and quality. Assists with reviewing medical necessity and obtaining authorization for urgent or walk-in visits. Refers patients to financial counselors to resolve complex financial issues and/or inquiries. (essential)

Follows BIDMC policies, procedures and training materials to ensure compliance to federal, state, and contractual requirements. (essential)

Identifies trends and provides periodic reports to departments on operational, productivity, and quality metrics. (essential)

Performs other activities on an as-needed basis to support the department. (essential)

Qualification

CPT codingHCPCS codingICD-9 codingICD-10 codingMicrosoft applicationsFinancial Clearance experiencePayer policies knowledgeCraneware softwareCustomer ServiceDecision MakingProblem SolvingWritten CommunicationsOral CommunicationsTeam Work

Required

High School diploma or GED required

1-3 years related work experience required

Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) coding and International Classification of Diseases (ICD-9, ICD-10)

Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases