Financial Clearance Specialist

Job Description

Networks Connect is conducting a search on behalf of our client, a prominent health system, for a detail-oriented Financial Clearance Specialist to join their Patient Access team. As a Financial Clearance Specialist, you will play a crucial role in optimizing financial outcomes by reducing first-pass denials and increasing point-of-service collections. This position involves using quality auditing tools to identify denial trends and working closely with referring physicians, payers, and patients to ensure comprehensive audits of patient data and financial obligations before care is provided.

Key Responsibilities:

• Financial Audits and Reporting: Utilize auditing and reporting tools to identify denial issues and trends by staff member, clinical area, payer, and provider. Conduct thorough audits of patient data to ensure accuracy in financial responsibilities.
• Collaborative Process Improvement: Work directly with Business Operations, Managed Care, and other departments to implement process improvements based on audit outcomes.
• Appeals and Denial Management: Write and manage appeals for authorization denials, ensuring recovery of payments and strengthening the organization’s financial health.
• Training and Education: Provide training and educational support to managers and staff, fostering continuous improvement and adherence to patient access standards.
• Revenue Cycle Management: Conduct monthly audits, analyze trends and outcomes, and present findings to leadership. Collaborate with various departments to minimize first-pass denials and optimize revenue cycle processes.
• Insurance Verification and Pre-Registration: Perform pre-registration, verify insurance eligibility, validate pre-certification or referral status, and communicate patient financial responsibilities. Ensure all scheduled patients are financially cleared prior to service.
• Point-of-Service Collections: Estimate patient financial responsibilities and initiate the collection process at the point of service. Assist patients with payment assistance options and coordinate with the Financial Information Center (FIC).

Qualifications:

• Education: Associate’s Degree in a health-related or business-related field (Required).
• Experience: Minimum of 4 years in healthcare business operations, patient access, or revenue cycle management. Prior experience with auditing and root cause analysis is essential.

Skills and Knowledge:

• Proficiency in Microsoft Office products.
• Superior customer service, verbal communication, and interpersonal skills.
• Strong problem-solving abilities and attention to detail.
• Knowledge of insurance guidelines for governmental and non-governmental carriers.
• Experience with Cerner, Passport, or related software and EMRs (preferred).
• Bilingual abilities are an advantage.
• Completion of all Patient Access training assessments required.

Why Join Us?

At Networks Connect, we value our employees and provide them with a supportive environment where they can grow and develop their careers. As a Financial Clearance Specialist, you will be an integral part of their mission to deliver exceptional patient care and improve financial outcomes. Join us in making a difference!

Job Type: Full-time

Pay: $50,000.00 – $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Education:

• Associate (Required)

Experience:

• Root cause analysis: 3 years (Required)

Ability to Commute:

• Silver Spring, MD (Required)

Work Location: In person

Earnings

$50,000 - $70,000 salary

Category

Revenue Cycle