Financial Clearance Specialist III - Authorizations Oncology

Financial Clearance Specialist III - Authorizations Oncology

locations

Remote - USA

Full time

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).

Duties & Responsibilities

• Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out-of-pocket cost share and financial assistance referrals.
• Initiates and tracks referrals, insurance verification and authorizations for all encounters. 
• Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles.
• Works directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier.
• Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status.
• Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements.
• Reviews and follows up on pending authorization requests.
• Coordinates and schedules services with providers and clinics.
• Research delays in service and discrepancies of orders.
• Assists management with denial issues by providing supporting data.
• Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing.
• Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services.
• Assists Medicare patients with the Lifetime Reserve process where applicable.
• Reviews previous day admissions to ensure payer notification upon observation or admission.
• Answer incoming patient or client call/email requests and handle in a prompt, courteous and professional manner.
• Communicate effectively with patient by simplifying complex information.

Minimum Requirements

• Proficient knowledge of Medicare, Medicaid MCO Plans, Manage Care and Commercial Insurances as it relates to account receivables
• Knowledge of medical terminology, anatomy and physiology, and ICD-10 and CPT/HCPCS code sets
• Minimum 3-5 years of experience in health care billing and reimbursement analysis.
• Knowledge of medical and insurance terminology, specifically regarding oncology and infusions.
• Excellent verbal communication, telephone etiquette, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.
• Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues.
• Ability to prioritize work based on criticality and re-prioritize as STAT cases are submitted
• Demonstrate dependability, critical thinking, and creativity and problem-solving abilities. Applies critical thinking skills to identify and resolve problems proactively and identify patient responsibility
• Basic working knowledge of UB04 and Explanation of Benefits (EOB).
• Knowledge of the Patient Access and hospital billing operations of Epic.
• Outstanding organization and time management skills 
• Proficient computer knowledge including MS Office with ability to enter data, sort and filter excel files
• High School Diploma or equivalent

Preferred Qualifications

• Experience in healthcare registration, scheduling, insurance referral and authorization processes
• Recent and relevant experience in an active coding production environment strongly
• Previous oncology experience preferred, including radiation treatments and general clinical knowledge
• Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes
• Experience utilizing EPIC, Cerner, or Meditech systems
• Bilingual in English and Spanish
• Knowledge of the Patient Access and hospital billing operations of Aria
• Bachelor’s degree

Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $22.00 to $26.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.