Financial Clearance Specialist 1

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).

Job Purpose

The Financial Clearance Specialist role ensures seamless and accurate processing of financial clearance procedures. Responsibilities include contacting insurance companies, physicians, and patients to ensure patient demographic and insurance information is collected, and that a financial clearance determination can be made. It will also inform patients of their rights, financial policies, and collects patient liabilities.

Duties & Responsibilities

• Process and verify administrative and financial components of financial clearance including validation of insurance benefits, medical necessity, routine and complex pre-certification, prior-authorization, scheduling and pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share.
• Obtain pre-certifications, authorizations, and referrals for upcoming appointments.
• Communicate recommended changes to schedules and care planning to ensure alignment with authorization requests and payor compliance
• Liaison between patient, insurance payors and providers to obtain prior authorization for prescheduled services
• Effectively address issues and offer information and support to both patients and physicians concerning financial clearance matters
• Process stat request prioritization
• Verify demographic information
• Apply payor changes to registration
• Verify, edit and/or remove user defined referral counts editing final status of referrals
• Edit the scheduled date within the referral, pend referrals to any pools, suppressing expiring referrals messages, accessing assigned referral work queues, defer/activate referral work queue items, use referral templates
• Apply critical thinking skills to identify and resolve problems proactively

Qualifications & Competencies

• High School Diploma or equivalent
• 3+ years’ experience with patient registration in a hospital or physician office, directly with obtaining patient demographic and financial information, handling insurance verification and obtaining authorizations
• Proficient with commercial and government insurance plans, payer networks, government resources
• Proficient with medical and insurance terminology
• Strong customer service skills, including ability to understand, interpret, evaluate, and resolve basic to complex service issues.
• Strong attention to detail and accuracy
• Excellent verbal and written communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, management, patients, client, and external agencies
• Ability to work with a variety of stakeholders
• Proficient in utilizing a variety of computer applications and software, including but not limited to Microsoft Office Suite, Internet Explorer, and other relevant programs
• Proven track record in roles that involve managing multiple critical priorities, with a focus on delivering high-quality results and meeting performance metrics

SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

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