Full Time Position




Job Summary:



As an integral member of Revenue Operations, under the direction of the Patient Financial Services Manager at Nantucket Cottage Hospital (NCH), responsible for obtaining and processing all necessary patient information to facilitate appropriate administrative insurance referrals and authorizations for services rendered within NCH, as well as outside of NCH if/when referred by an NCH affiliated physician. The Financial Clearance Specialist supports the goal of obtaining maximum insurance reimbursement while providing timely, efficient and high-quality service to patients, referring providers and other customers.



Essential Job Duties and Responsibilities



• Verifies patient demographic, physician and financial information. Identifies and appropriately addresses discrepancies within patient information to ensure accurate and timely patient care and notifies Patient Access when appropriate.


• Checks patient eligibility and benefits with insurance companies to ensure appropriate coverage of services. Requires an in-depth knowledge of the referral/authorization processes and insurance stipulations that may affect service provision to the patients at NCH. Obtains referrals and authorizations as needed prior to service.


• Coordinates with registration and scheduling to ensure efficient and timely requested services. May be required to facilitate scheduling/rescheduling appointments and services at NCH, if the authorization is unobtainable.


• Maintains open communication with ordering/performing Physician offices and Specialty Clinicians whenever clinical clarification is required.


• Obtains authorization for all appropriate tests and procedures by providing necessary information as required by third party payers. Requires understanding of coordination of benefits (COB).


• Assist with insurance claim review and appeals when denials are received based on Financial Clearance.


• Maintain current insurance requirements regarding referrals and authorizations via a master resource log. Required to have knowledge of patient eligibility/authorization process for various third-party payers. Ensures that he/she has the most up-to-date information on any changes to insurance contracts and/or insurance requirements.


• Continuous education on industry standards and on-line opportunities related to authorizations/referrals, i.e. attending webinars, know where to find the info online and applying new learned knowledge.


• Determines and informs patient of potential liability prior to admission. Refers patients to Patient Financial Counselor for estimate, when issues with patients' insurance coverage are identified or the patients are unable to meet financial obligation. Collaborates with physicians and staff to coordinate rescheduling of patients until reimbursement can be guaranteed.


• Effectively manages and addresses respective Work Queues within the Epic System as assigned and adheres to performance standards. Maintains a 97% accuracy rating. Address any authorization and referral denials that effect the overall performance rating.


• Informs the Supervisor/Manager of issues related to referrals/authorizations and patient care timely.


• Performs charge posting and charge verification in support of the OR. Follows-up with OR Manager and clinicians as needed for completion.


• Follow up with ordering providers for additional diagnosis on NCH Lab Claim edits when coding identifies lack of medical necessity.


• Assist patients and colleagues with triaging HIM related inquiries. Collaborate when requested with MGB Centralized ROI department to assist in fulfilling medical record requests.


• Coordinate the receipt of paper documentation that supports the care and treatment received by the patient as part of the EHR system requirements and scan into the system:


• Verify that the paper support documentation is correctly identified with the patient demographic data and/ or the visit account.


• Prep the paper documents and scan.


• Respects patient confidentiality always and exercises best practice in dealing with sensitive, confidential information.


• Contributes to teamwork within and between NCH Departments. Provides coverage for fellow Referral/Authorization Coordinators within department during their absences.


• Communicates in a courteous and professional manner. Wears appropriate clothing to a medical office setting.


• Maintains work area in a tidy manner and stores supplies properly.


• Willingness to perform other duties as assigned.


• Actively participates in performance improvement initiatives.



Qualifications

Qualifications and Skills Required for Position




Knowledge of:



§ Comprehensive understanding of medical terminology and managed care plans.


§ Working knowledge of Microsoft Office applications.


§ EPIC applications and their associated workflows as it relates to the position



Skills:



§ Computer literacy and efficiency


§ Excellent customer service skills


§ Demonstration of effective interpersonal skills


§ Command of the English language including some medical terminology.


§ Exceptional organization skills, ability to multi-task, accurate attention to detail.


Ability to:



§ Interact cordially and professionally with Hospital employees, visitors, and vendors


§ Work both independently or with a team approach


§ Problem solve and function as a resource to other members of the team


§ Articulate the fundamentals of the position, describe the workflow and associated duties.


§ Use hands and fingers to operate department equipment


§ Stand, sit, walk, climb, bend, use knees, use back (some crawling required)


§ Lift up to 20 pounds.


§ Vision is required to review, read and input data. Hearing is required in order to receive information via telephone or in person. Verbal skills are required in order to provide and receive information. The use of hands/fingers is required for data input.



Credentials and Experience Required


§ High School Degree or GED required.


§ Associates Degree preferred.


§ 1-2 years' experience in successfully obtaining authorizations/ referrals directly from the insurers/ payers preferred.


§ Experienced with proven ability in navigation of all insurances' electronic resources.



Special Requirements



• Regular work week requiring minimal overtime.


• Exposure to normal office environment. May also be exposed to temperature fluctuations, moderate noise levels, minimal dust, infectious diseases and chemicals that are commonly used in a hospital setting.


• Must be available to work in the case of a Hospital declared emergency.



EEO Statement

Nantucket Cottage Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.