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Signature Healthcare
Financial Clearance SpecialistSignature Healthcare • West Bridgewater, Massachusetts, United States, 02379
Financial Clearance Specialist

Financial Clearance Specialist

Signature Healthcare • West Bridgewater, Massachusetts, United States, 02379
23 hours ago
Job type
  • Full-time
Job description


Financial Clearance Specialist

Signature Healthcare is Southeastern Massachusetts’ premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.

Position Summary:

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.

Location: 750 W. Center Street, West Bridgewater, MA

Department: Financial Clearance Specialist

This is a full-time 40 hour/ week position

Responsibilities:

  • 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, workers compensation insurance, third parties, behavioral health or others as required.
  • Ensures all possible coverage’s are created and verified, through electronic or manual methods, and all discrepancies are resolved.
  • Validates that coverage’s 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 coverage’s 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.

Education/Experience/Licenses/Technical/Other:

  1. Education: High school graduate or equivalent
  2. Experience: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.
  3. Certification/Licensure:
  4. Software/Hardware: Meditech experience preferred.
  5. Other:





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Financial Clearance Specialist • West Bridgewater, Massachusetts, United States, 02379

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