Financial Clearance Specialist

Role Overview

• Verifies patient's insurance eligibility for visit, using online tools and by contacting the payer.
• Identifies payer medical necessity determination before services are rendered.
• Determines authorization requirement and obtains authorization from payer.
• Identifies and escalates issues for resolution while communicating with revenue cycle peers and clinical stakeholders.
• Completes assigned work queues and reports daily to achieve productivity standards.
• Follows BIDMC policies and procedures to ensure compliance to regulations.
• Identifies trends and provides periodic reports to departments.

Requirements

• High School diploma or GED required. Associate's degree preferred.
• 1-3 years related work experience required.
• Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) coding and International Classification of Diseases (ICD-9, ICD-10).
• Advanced skills with Microsoft applications (Outlook, Word, Excel, PowerPoint or Access).
• Must be able to summarize and communicate in English moderately complex information in varied written formats.

Benefits

• Health insurance
• Paid time off
• Professional development opportunities