Patient Financial Clearance Specialist

The Financial Clearance Specialist plays a crucial role in ensuring the financial stability of the organization by managing the authorization processes for surgical procedures and patient admissions. This position is responsible for submitting Notices of Admissions (NOA) to payers, securing surgical authorizations, verifying surgical authorizations are on file, and providing patients with accurate cost estimates for services. The Financial Clearance Specialist ensures compliance with the No Surprises Act, helping the organization maintain compliance with federal regulations. Obtaining timely and accurate authorization information, prior to performing services, reduces claim denials, ensures payer compliance, and establishes better organizational financial outcomes. Patient experience and provider relations are enhanced through the smooth transition of this role's responsibilities of securing the authorizations and providing accurate estimates. This role is key to maintaining the smooth operation of patient care and experience, while safeguarding timely reimbursements from insurers. Duties and Responsibilities: Request and obtain prior authorizations via the insurance carrier and/or third-party authorization companies and then track the status within CNE’s EHR. Evaluate payer policies to understand authorization and notice of admission policies. Communicate the request/status of the insurance referral and/or prior authorization with internal referring provider offices/departments via the EHR. Complete the notification and insurance verifications for hospital admissions. Responsible for ensuring the organization is compliant with the No Surprise Act. Review estimates with patients prior to services being rendered. Assist patients with applying for CNE Charity care. Connect patients with Financial Counselors to be screened for eligibility. Utilize CNE’s EHR to document all work related to obtaining and/or verifying prior authorizations. Work with both internal and external referring provider offices/departments to obtain the necessary information to obtain and/or verify the approval of prior authorization. Verify the accuracy of the patient’s insurance information to obtain prior authorization. Communicate any issues related to obtaining and/or verifying the approval of the prior authorization to management. Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients. Work and monitor EHR WQ’s and in Basket pools through the workday. Perform other duties as assigned. Requirements: High School or GED is required; Associate degree or Certified/Registered Medical Assistance preferred. 5-7 years of experience working in healthcare. 3 years of experience submitting notice of admissions and/or prior authorizations and/or pricing estimates.

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