[Remote] Financial Clearance Specialist

Note: The job is a remote job and is open to candidates in USA. Northwestern Medicine is a leader in the healthcare industry, dedicated to providing exceptional patient care. They are seeking a Financial Clearance Specialist who will be responsible for ensuring that all admissions and scheduled surgeries are financially cleared to maximize timely reimbursement, while also providing outstanding customer service and support to patients and staff regarding insurance-related issues.ResponsibilitiesConsistently practices Patients First philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphereResponds to questions and concernsForwards, directs and notifies Team Lead or Operations Coordinator of extraordinary issues as necessaryMaintains patient confidentiality per HIPAA regulationsProvides exceptional customer service to consumers which establish a positive first impression of Northwestern MedicineExceeds all consumer requests and alerts management of issues or concerns that require escalationCorrectly identifies and collects patient demographic information in accordance with organization standardsResponds to telephone inquiries and performs appropriate action(s)Documents all actions taken in the appropriate software applicationsMonitors admission/registration and scheduled surgeries flow of patient information through the revenue cycleServes as a resource to staff and patients for insurance related issuesHas a strong understanding of Medicare/Medicaid rules and regulations, and managed care productsIs knowledgeable of current contracted and non-contracted healthcare insurance plansReviews patient electronic medical record for appropriate diagnosis and pre-treatment renderedHas thorough understanding and working knowledge of CPT and ICD-10 codingConsults with physicians and their assistants whenever questions arise to insure timely approvalsFollows through and makes corrections in demographics and insurances as they are discoveredData entry accuracy is imperative in this positionMonitors Referral In-Basket in EPIC to insure work is consistently completed in a timely mannerThis involves watching for future test requests to come due and then pre-authorized within the time frame specified by the insurance carrier and the patient notifiedFacilitates the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, through the use of online tools, work lists, and direct phone calls as necessary to ensure maximized patient benefitsEnsures all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared, to allow for maximum and timely reimbursement to the hospitalInteracts with various hospital departments and physicians offices to effectively schedule and direct patients through the NMHC systems in a patient/customer friendly mannerPerforms medical necessity checks as necessary for scheduled services, communicates options to patient if appointment failsInforms patients of any issues with securing the financial account for their encounter and completes out-of-pocket estimations as requested by patientsProvides training and education as neededManages work schedule efficiently, completing tasks and assignments on timeParticipates in Quality Assurance reviews to insure integrity of patient data informationUses effective service recovery skills to solve problems or service breakdowns when they occurUtilizes department and hospital policies and procedures to complete assigned tasksPerforms duties within the regulatory guidelines of the Fair Patient Billing Act and the Fair Debt Collection ActOther duties as assignedCommunicates information to the patient regarding questions about physician referrals, insurance referrals and consultationsCollects authorization numbers in appropriate systems as applicableProvides professional and constructive environment for communication across units/departments and resolves operational issuesMay attend intra/interdepartmental meetings which involve walking within NM CampusCommunicates customer satisfaction issues to appropriate individualsDemonstrates teamwork by helping co-workers within and across departmentsCommunicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of othersEnsures that outpatient procedures have a valid diagnosis code, and that for Medicare patients, medical necessity has been metCommunicates with physician offices to troubleshoot failing medical necessity for Medicare patientsContacts patients to notify them of high out-of-pocket liabilities, and to establish/enforce compliance with hospital financial policiesReviews and analyzes all required demographic, insurance/financial and clinical data procured by patient intake and registration areas necessary to expedite payment on patient accountsVerifies eligibility and benefit information using on-line programsPerforms pre-certification notification via telephone or electronically and gathers and completes all required documentation for submission to insurance carriers per payor requirementsParticipate in researching pre-certification denials including missing authorization, patient pre-certification or referral documentationWorks on denied accounts with ancillary departments, physician and account representatives to gather required informationCross-training between various departments may take place to insure coverageUtilizes multiple online order retrieval systems to verify or print the patients orderVerifies insurance eligibility and benefit levels through the use of online tools (NDAS, ASF, etc.) or over the phone as necessaryCompletes accurate handoff instructions and notes to scheduling staff, by noting appropriately in EpicDemonstrates ability to use all computer applications efficiently and to the capacity needed in this positionProactive in preventing issues with patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, communicating relevant information and documenting order retrieval in notes for check-in personUnderstands minimum data set required for a complete registration, collects and verifies critical data and updates that information into registration systemUnderstands departmental and individual quality metricsProactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutionsEvaluates procedures and suggests improvements to enhance customer service and operational efficiencyParticipates in departmental quality improvement activitiesProvides ideas and suggestions for process improvements within the departmentMonitors registration and scheduling, including insurance verification to insure processing within prescribed quality standardsAdjusts processes as needed to meet standardsUses organizational and unit/department resources efficientlyActs as a training resource for new staff and a resource for coworkers, sharing process and workflow informationSkillsHigh School Diploma or equivalent2-3 years previous hospital billing, insurance follow-up, or customer service in a hospital settingExcellent interpersonal, verbal, and written communication skillsProficiency in computer data-entry/typingExcellent verbal and written communication skillsAbility to read, write, and communicate effectively in EnglishBasic computer skillsAbility to type 40 wpmAbility to multi-taskCustomer service orientedExcellent organizational, time management, analytical, and problem solving skillsBachelors DegreeAdditional language skillsHealthcare finance and/or healthcare insurance experienceKnowledge and experience in a healthcare setting, especially patient scheduling and/or registrationBenefitsTuition reimbursement and loan forgiveness401(k) matching and lifecycle benefitsSign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.Company OverviewNorthwestern Medicine is the collaboration between Northwestern Memorial HealthCare and Northwestern University Feinberg School of Medicine around a strategic vision to transform the future of health care. It was founded in 1972, and is headquartered in Chicago, Illinois, USA, with a workforce of 10001+ employees. Its website is http://nm.org.