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Financial Clearance Specialist (Pre-authorization)

JOB SUMMARY:
Assists in financial clearance relating to patient care with occasional guidance. Screens patients for referral to other funding resources.


KEY RESPONSIBILITIES:

• Obtains certification from insurance companies for all office visits.
• Verifies insurance information and registers cases in tracking system.
• Evaluates patient assets and liabilities to determine ability to pay.
• Reviews alternatives to admission and guides patient in applying for financial assistance.
• Completes pre-certification, credit applications, and other necessary paperwork.
• Performs investigative and follow-up work relating to reimbursement issues.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

INSURANCE REGULATORY KNOWLEDGE (INTERMEDIATE): - Demonstrates knowledge of the appropriate rules and regulations for insurance policies, claims, payment and coverage. Ability to interpret and explain rules and regulations that are ambiguous or unclear.

CUSTOMER SERVICE (NOVICE): - A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs.

DATA ENTRY (NOVICE): - The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.

PROBLEM SOLVING (NOVICE): - Uses critical thinking and process improvement i.e. coaches and mentors development of problem statement, describes current state, identifies root causes, creates future state, coaches and mentors development of solutions and action plans with a sustainability plan. Applies appropriate tools to address issues.

CORE ACCOUNTABILITIES:

• Organizational Impact: Performs tasks that are typically routine that may impact team's performance with occasional guidance.
• Problem Solving/ Complexity of work: Utilizes some discretion and research to solve routine problems.
• Breadth of Knowledge: Applies knowledge of standards, established processes and procedure that apply to your own job.
• Team Interaction: Provides guidance to entry level co-workers.