财务清偿周期助理

Revenue Cycle Associate - Financial Clearance
Employment Type: Full Time
Location: Remote
Reports To: Manager, Financial Clearance
You must reside in one of these states to be eligible for this position:
Arkansas    California    Kentucky
Massachusetts Nevada    New Mexico
Oregon     Utah     Tennessee
Texas     Wyoming
Job Summary:
The Revenue Cycle Associate, Financial Clearance position is responsible for ensuring that a patient’s visit is financially cleared prior to the date of service. The role includes verifying patient insurance eligibility/benefits, calculating patient liability estimates, securing prior authorization, providing notice of admission, obtaining referrals, and verifying medical necessity. These efforts will result in increased net revenues by reducing front-end related denial write-offs. Interactions will be conducted with providers, payers, patients, and hospital-based personnel. Duties are to be performed accurately and timely while providing exceptional customer service.
Key Responsibilities:

• Ensures Financial Clearance (e.g., verification of eligibility/ benefits, securing prior authorization, etc.) is obtained timely prior to the patient’s date of service based on service line and departmental policies.

• Performs coverage discovery using eligibility tools to identify additional insurance coverage if existing insurance on file is inactive.

• Calculates and clearly documents patient liability estimates based on patient’s verified benefit information.

• Provides payers with timely inpatient and observation Notices of Admission (NOA) as required based on payer-specific guidelines.

• Validates prior authorization has been obtained and follows up with providers via phone as required for applicable services lines.

• Verifies medical necessity for applicable patients and identifies instances where a Medicare Advance Beneficiary Notices of Noncoverage (ABN or NONC) is required.

• Escalates instances where Financial Clearance may not be obtained (e.g., unable to obtain authorization) prior to patient’s DOS to appropriate stakeholders in accordance with departmental deferral policies.

• Resolves insurance coverage and authorization information discrepancies as identified through automated quality assurance tool.

• Works denials related to referral, authorizations, notifications, non-coverage, and medical necessity as assigned. This includes, but is not limited to, coordinating with appropriate stakeholders to submit rebills or appeals and obtaining retro authorization when required.

• Observes privacy, safety, and security procedures, and uses equipment and materials properly.

• Possesses the ability to work within a remote call center environment, free from distractions and background noise.

• Recognizes and consistently exhibits exceptional customer service as a critical factor in all duties performed.

Required Skills & Qualifications:

• Proficient in typing.

• General knowledge of medical terminology.

• Ability to communicate effectively and professionally in English, both verbally and in writing.

• Critical thinking and problem-solving skills.

• High school graduate or equivalent.

• One year of related experience in the medical field is preferred.

Benefits:

• Competitive salary and benefits package.

• Opportunities for professional development and advancement.

• Supportive work environment with a collaborative team.

• Comprehensive healthcare coverage.

• Retirement savings plan.

• Paid time off and flexible scheduling options.

• Student loan repayment program.

Originally posted on Himalayas