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CHA Hollywood Presbyterian Medical Center · 7 hours ago

Financial Clearance Specialist - Duarte

United States-California-Irwindale

Full-time

Onsite

Mid Level

$25.02/hr - $35.03/hr

3+ years exp

City of Hope is a transformative organization focused on changing lives in the fight against cancer and other life-threatening illnesses. The Financial Clearance Specialist will coordinate insurance authorizations, perform pre-registration functions, and ensure a high level of customer service to patients and their families.

Health CareHospitalMedical

Responsibilities

Identifies insurance companies requiring prior authorization for services and obtains authorization

Coordinates authorizations for procedures and testing requested by providers for their managed care patient

Reviews charts on outpatients and reports to third party payors

Retrieves chemo/surgery orders from chart, and requesting authorization through the insurance companies

Prepares all forms required by third party payor for treatment authorization requests

Work on all pending utilization review patients, and achieve authorization for the following day

Getting emergent authorizations from walk-in patients

Verifying with the insurance companies and documents what needs to be pre-certified

Educates patient of their insurance policy

Composes letters and memoranda from physician dictation, or verbal direction for submission to insurance companies to obtain authorization or appeal denials

Maintains current records on managed care patients

Keeps Case Managers updated on all BMO and BMT patients

Performs pre-registration functions prior to the patient appointment (including, but not limited to: obtains and/or verifies demographic, clinical, financial, insurance information, service eligibility, consent forms, and patient/guarantor information for pre-registered accounts)

Contacts patients, payers, or other departments to confirm and verify insurance and demographic information

Refers patients to financial counselors to resolve insurance or payments issues

Identifies and resolves issues by working with patients, payors, and/or other CoH departments and personnel in a single interaction with the patient

Identifies patients with 'share of cost' or co-payments by performing pricing estimations, and notifies patients of their expected patient liability and financial responsibility

Collects patient/guarantor liabilities and refers patients who are uninsured/underinsured to Financial Counselor for charity, financial assistance or governmental program screening and application processes

Notifies CoH contracting department of patients with a non-contracted insurance to prepare a Letter of Agreement (LOA) should patient to pursue services at COH and informs patient of approval status

Performs activities required to financial clearance for all patient types

Ensure a high level of customer service by greeting, being a resource to patients and visitors

Serve as a liaison between patients and support staff

Develop effective relationships with colleague, physicians, providers, leaders and other employees across the organization

Demonstrates genuine interest in helping our patients, providers and other employees by using excellent communication skills, being polite, friendly, patient and calm under pressure

Managing multiple, changing priorities in an effective and organized manger, under stressful demand while maintaining exceptional service

Maintain composure when dealing with difficult situations and responding professionally

Independently recognize a high priority situation, taking appropriate and immediate action

Effectively communicates with service delivery and other departments to resolve issues that impact patient care and escalating issues that cannot be resolved in accordance with departmental guidelines

Answering daily phone calls and pages from doctors, patients, employees and insurance companies

Qualification

Healthcare pre-registration experienceReferral coordinationMedical terminologyElectronic medical recordEPIC EMR experienceCustomer serviceCommunication skillsOrganizational skills