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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.