Financial Clearance Specialist

JOB RESPONSIBILITIES

• Provide expert guidance to patients and families by explaining insurance benefits coverage limitations estimates and financial responsibility for planned or received services
• Interpret and explain benefits explanations of benefits (EOBs) authorizations denials and payer determinations to patients and families
• Document benefit details estimates and financial discussions accurately within the EHR
• Ensure compliance with CMS-required notices the No Surprises Act and price transparency requirements including delivery and explanation of patient estimates
• Establish and negotiate payment plans with patients as appropriate and in accordance with organizational policy
• Serve as the first point of contact for explaining Shepherd Centers Financial Assistance Program (FAP) and coordinate submission of required documentation
• Perform POS collections maintain cash drawer accuracy process credit card transactions and communicate effectively with patients and guarantors regarding balances
• Collaborate closely with Insurance Verification Specialists escalating complex coverage authorization or financial clearance issues as needed
• Receives escalations from Insurance Verification Specialists for complex financial clearance scenarios
• Partner with Patient Financial Services Case Management Managed Care and insurance carriers to resolve complex financial and coverage scenarios
• Meet with patients and families in clinics or at the bedside as required demonstrating compassion professionalism and financial expertise
• Answer incoming calls respond to voicemails and emails and route patient inquiries appropriately in a timely manner
• Maintain working knowledge of registration workflows and provide cross-coverage support for outpatient clinics as needed
• Practices proper safety techniques in accordance with Center and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents or other safety issues to the supervisor and in the occurrence notification system.
• Monitors and ensures compliance with all regulatory requirements organizational standards and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process.

REQUIRED MINIMUM EDUCATION

• High School Diploma or GED required

REQUIRED MINIMUM CERTIFICATION

• N/A

REQUIRED LICENSURE

• N/A

REQUIRED MINIMUM EXPERIENCE

• 35 years of progressive experience in patient access financial clearance healthcare billing or related revenue cycle functions preferably in a hospital or physician enterprise.

REQUIRED MINIMUM SKILLS

• Strong working knowledge of commercial managed care and governmental insurance plans
• Demonstrated ability to interpret benefits authorizations and payer determinations independently
• Strong math aptitude and financial acumen
• Excellent written and verbal communication skills
• Proficiency with Epic and Microsoft Office tools
• Ability to manage sensitive financial conversations with professionalism and empathy

PREFERRED QUALIFICATIONS

• Associates or Bachelors degree preferred
• CPAR or CHAA preferred
• CHAM or HFMA CRCR a plus

PHYSICAL DEMANDS

• Sedentary work with occasional standing walking or lifting up to 15 pounds.

WORKING CONDITIONS

• No potential for exposure to blood and body fluids.