Job Information
Brockton Hospital Financial Clearance Specialist in West Bridgewater, Massachusetts
Financial Clearance Specialist , Full-Time, Days
Signature Healthcare’s Brockton Hospital is hiring for a Full-Time, Day Shift Financial Counselor in Brockton, MA.
Type: Full Time Shift: Days Shift Details: 8a-4:30p
Location: 750 W. Center Street, West Bridgewater, MA
Financial Clearance Specialist Roles and Responsibilities:
Financial Clearance Specialist ensures all necessary information is proactively obtained and verified for proper financial reimbursement of services provided while maintaining a positive patient experience.
Accesses work queues and reports and reviews patient accounts to determine financial clearance status of specific patient services.
Takes action on those services without financial clearance.
Ensures demographic and patient contact information is complete and verified with the patient or patient representative.
Verifies the guarantor type and information and ensures it is assigned to the account correctly. This includes personal/family relations, worker compensation insurance, third parties, behavioral health or others as required.
Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved.
Validates that coverages are assigned to appropriate visit.
Collects and validates order-related information including office visit, radiology and surgical orders.
Follows up with ordering provider to verify CPT codes.
Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices.
Enters and links referrals and/or authorizations in system.
Processes referrals when necessary, assuring proper tracking and redirection when appropriate.
Using system activities and functions, identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for registration team. Documents account for registrar action.
Analyzes clinical documentation in support of ordered procedure(s) and submits precertification requests through various insurance fax lines, phone systems and web portals.
Follows up on pending accounts and involves ordering provider offices as needed to obtain approvals.
Escalates challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery.
Verifies covered benefits, including remaining hospital days, carve out coverages and benefit limits of visit and/or timeframe.
Contacts patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies.
Understands clinical guidelines for payers requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.
Communicates with patients and discusses their financial clearance status when necessary.
Required Skills & Qualifications:
At Signature Healthcare we offer an inclusive and welcoming culture for our employees to grow and flourish., so if you're interested in this opportunity but your experience does not align with every qualification, we encourage you to apply. You may be just the right candidate for this or other opportunities.
Required
High school graduate or equivalent
At least two years prior experience in a health care setting requiring knowledge of insurance coverage, reimbursement, and/or medical terminology and coding.
Experience providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data.
Preferred
Meditech experience preferred.
Working at Signature Healthcare
For 125 years, Signature Healthcare has been dedicated to delivering personalized healthcare services in a welcoming and medically advanced environment as one of the only not-for-profit community-based healthcare systems in Southeastern Mass. Our focus on quality care, matched with our commitment to serving every individual, fosters an inclusive and supportive environment for our employees to grow and flourish in their careers. Join Signature Healthcare and enjoy a fulfilling work experience, complemented by our comprehensive benefits package, including but not limited to:
Medical, Dental, and Vision
Life and Disability
Retirement Savings Plan
Employee Assistance Program (EAP)
Voluntary Benefits (Accident, Home & Auto, Pet, etc.)
Tuition Reimbursement
PTO and Paid Holidays
Apply today with Signature Healthcare and help us become better and stronger than ever.
