Senior Revenue Cycle Associate - Financial Clearance

Senior 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 Senior Revenue Cycle Associate, Financial Clearance position is responsible for ensuring that a patient’s visit is financially cleared prior to the date of service. This position serves as the subject matter expert and go-to resource for peers, providing guidance on complex registration, insurance, workflow, and patient financial responsibility matters. 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. This position is not a formal supervisory role.
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