Financial Clearance Specialist-Per Diem
Company: Beth Israel Lahey Health
Location: Winchester
Posted on: May 17, 2024
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Job Description:
Job Type: Per Diem
Time Type: Part time
Work Shift: Day (United States of America)
FLSA Status: Non-Exempt
When you join the growing BILH team, you're not just taking a job,
you're making a difference in people's lives.
Ensures that all information necessary for proper financial
reimbursement for patient care is collected and verified prior to
the patient's date of service. Collaborates with insurance
companies when necessary to proactively validate benefits,
eligibility and referral requirements. Communicates with patients
to assure they understand their payment obligations and steps
necessary to meet these obligations, while maintaining a positive
patient experience.
Job Description:
Essential Duties & Responsibilities including but not limited
to:
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 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 visit-related registration information
including MSPQ, occurrence codes, and attending and referring
providers.
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 in system.
Processes referrals when necessary, assuring proper tracking and
redirection when appropriate. Understands each clinical
department's referral certification protocols and ensure referrals
are certified at the appropriate level.
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.
Assists with precertification process when required.
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,
Communicates with patients and discusses their financial clearance
status when necessary. Explains the status of any services not
financially cleared and advises patients of the proper resolution
steps, including self-payment. Directs patients to Lahey Financial
Counselors when appropriate.
Works with the Financial Counselors, clinical departments, outside
providers, third party insurers and any other individual or entity
to assist in resolving patient financial clearance questions or
problems in the most effective and positive manner possible.
Research claim edits and payment denials related to financial
clearance and works closely with the Lahey Patient Financial
Services staff to resolve these denials. Communicates resolution to
patients.
Minimum Qualifications:
Education:
High school degree or equivalent
Licensure, Certification & Registration:
None
Experience:
Prior experience in a business setting requiring knowledge of
health insurance coverage and/or reimbursement. Experience
providing customer service, while processing and verifying
electronic demographic, financial or other business-related
information and data.
Skills, Knowledge & Abilities:
Able to work successfully in a fast-paced, multi-task environment,
where some independent decision making is necessary. Able to
process electronic information and data accurately and
efficiently.
As a health care organization, we have a responsibility to do
everything in our power to care for and protect our patients, our
colleagues and our communities. Beth Israel Lahey Health requires
that all staff be vaccinated against influenza (flu) and COVID-19
as a condition of employment. Learn more
(https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31)
about this requirement.
More than 35,000 people working together. Nurses, doctors,
technicians, therapists, researchers, teachers and more, making a
difference in patients' lives. Your skill and compassion can make
us even stronger.
Equal Opportunity Employer/Veterans/Disabled
Keywords: Beth Israel Lahey Health, Arlington , Financial Clearance Specialist-Per Diem, Accounting, Auditing , Winchester, Massachusetts
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