Financial Clearance Lead

Overview

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Job Details

The Financial Clearance Lead is responsible to ensure completion and accuracy of insurance verification and benefits, authorization, patient financial responsibility, and other patient access operational activities for Catholic Health Services of Long Island (CHSLI). The role will provide the department with enhanced subject matter expertise for all in-scope financial clearance activities. The Lead role will leverage extensive financial clearance experience to support staff through job shadowing, training, and first level account escalations. The role will support management by identifying process improvement opportunities and implementing action plans.

LEAD RESPONSIBILITIES

The Lead role will provide an additional layer of oversight to daily operations, specifically aimed at supporting account escalations and department subject matter expertise.

• Utilize work drivers and reports, as assigned by management, to ensure completion of financial clearance functions for all in-scope patients. The Lead role may be asked to focus on complex service lines and/or account escalations.
• Support staff development through daily job shadowing, training, and account escalations. The Lead role will act as the “first line of defense” for staff questions.
• Provide management with actionable feedback on process improvement opportunities, and support the implementation of action plans and/or new initiatives aimed at improving department performance.

REPRESENTATIVE RESPONSIBILITIES

In addition to the above responsibilities, the Lead role will also assume the following responsibilities as it specifically pertains to daily job duties.

• Confirm and document the patient’s health insurance(s) effective dates, network status, service coverage requirements, and patient liabilities including deductible, coinsurance and co-payment amounts. This may be completed multiple times before, during, and after a patient’s visit/stay.
• For scheduled services, review and analyze patient visit information to determine whether authorization is needed and utilize payer specific procedures to appropriately secure authorization in order to clear the account prior to service where possible.
• For non-scheduled services such as inpatient admissions, observation care, maternal care, and emergency surgeries and procedures, notify the patient’s insurance within 24 hours of admission or date of service, coordinate with Case Management and Utilization Management for insurance required documentation
• Use financial estimate process to make patients aware of estimated financial responsibility, collect and document receipt of estimated patient responsibility amounts prior to service, and appropriately refer them to financial counseling when necessary.
• Utilize problem solving skills to determine the best course of action to resolve any problems created as a result of insurance coverage or prior authorizations.
• Foresee and communicate to management team any significant issues/risks.
• Propose innovative ideas and solutions to enhance operational efficiencies.
• Maintain knowledge of The Joint Commission and state/federal regulations, laws and guidelines that impact Financial Clearance functions and Patient Access Services.
• Comply with Medical Necessity protocols and proper use of Compliance Checker and National Coverage Decisions.
• Maintain knowledge of Medicare, Medicaid and third-party payer regulations and hospital charging and collection policies.
• Responsible for other duties as assigned.

POSITION REQUIREMENTS AND QUALIFICATIONS

Education

High School Diploma or equivalent experience required

Skills

Role-Specific Behaviors : These behaviors are necessary in the role:

• Relationship-building – able to develop and maintain relationships with a variety of types of positions and individuals at both the hospital and system level.
• Motivation – able to motivate and mentor staff to perform at high levels of expertise and productivity.
• Problem Solving – Analyzes interrelated elements of problems and works systematically to solve them, uses sound judgment to develop efficient and feasible resolutions to challenging issues.

Skills, Knowledge or Abilities critical to this role

• Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology.
• Work requires the ability to access online insurance eligibility and pre- certification systems.
• Must have expertise in insurance, managed care and federal/ state coverage.
• Must be customer focused with strong interpersonal skills and courteous with patients, family members, physicians, and staff members.
• Must be able to discuss and complete financial arrangements on the estimated patient liability under stressful conditions while maintaining positive patient relations.
• Work requires a high level of problem solving skills
• Work requires the ability to interpret and execute policies and procedures.
• Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents.
• Must be able to demonstrate a working knowledge of personal computers and other standard office equipment
• Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in appearance and approach.
• Must be able to handle potentially stressful situations and multiple tasks simultaneously.
• Must be able to successfully complete additional job related training when offered.

Experience

Minimum experience of 3 years in Revenue Cycle, Patient Access Services. Insurance Verification and Insurance Pre-Certification/Authorization experience required. Must exude a strong understanding of Financial Clearance activities and hospital insurance requirements.

Posted Salary Range

USD $30.00 - USD $35.00 /Hr.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.