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Care New England · 13 hours ago

Patient Financial Clearance Specialist

Warwick, RI

Full-time

Onsite

Mid, Senior Level

5+ years exp

Care New England is a health system that focuses on medical research and providing top-tier healthcare services. The Patient Financial Clearance Specialist is responsible for managing authorization processes for surgical procedures and admissions, ensuring compliance with regulations, and enhancing patient experience through effective communication and accurate cost estimates.

AssociationHealth Care

Responsibilities

Request and obtain prior authorizations via the insurance carrier and/or third-party authorization companies and then track the status within CNE’s EHR

Evaluate payer polices to understand authorization and notice of admission policies

Communicate the request/status of the insurance referral and/or prior authorization with internal referring provider offices/departments via the EHR

Complete the notification and insurance verifications for hospital admissions

Responsible for ensuring the organization is compliant with the No Surprise Act

Review estimates with patients prior to services being rendered

Assist patients with applying for CNE Charity care

Connect patients with Financial Counselors to be screened for eligibility

Communicate the request/status of prior authorization with internal referring provider offices/departments via the EHR

Utilize CNE’s EHR to document all work related to obtaining and/or verifying prior authorizations

Work with both internal and external referring provider offices/departments to obtain the necessary information to obtain and/or verify the approval of prior authorization

Verify the accuracy of the patient’s insurance information to obtain prior authorization

Communicate any issues related to obtaining and/or verifying the approval of the prior authorization to management

Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients

Work and monitor EHR WQ’s and in Basket pools through the workday

Performs other duties as assigned