Financial Clearance Specialist II, Oncology

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Savista

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1001 - 5000 Mitarbeiter

Gegründet 1994

⚕️ Krankenversicherung

Healthcare Insurance

Savista ist ein Full-Service-Anbieter für das Revenue Cycle Management mit über 30 Jahren Erfahrung im Gesundheitswesen. Sie unterstützen Gesundheitsorganisationen dabei, finanzielle Ergebnisse zu verbessern, indem sie Dienstleistungen wie Forderungsmanagement, Ablehnungsmanagement, klinische Dokumentationsintegrität, Anspruchsberechtigung & Anmeldung sowie HIM-Outsourcing anbieten. Savista fungiert als Erweiterung der Gesundheitsteams, um Prozesse zu optimieren und die Effizienz zu steigern, um die Compliance sicherzustellen und patientenorientierte Servicequalität zu fördern. Das Unternehmen hat Anerkennung und branchenspezifische Auszeichnungen für seine effektiven und qualitativ hochwertigen Lösungen erhalten.

Beschreibung

• Processes administrative and financial components of financial clearance including validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out-of-pocket cost share and financial assistance referrals. • Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles. • Pre-registers patients by obtaining demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing. • Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services. • Assists Medicare patients with the Lifetime Reserve process where applicable. • Reviews previous day admissions to ensure payer notification upon observation or admission. • Answer incoming patient or client call/email requests and handle in a prompt/kind, courteous and professional manner. • Communicate effectively with patient by simplifying complex information.

🎯 Anforderungen

• Proficient knowledge of Medicare, Medicaid MCO Plans, Manage Care and Commercial Insurances as it relates to account receivables • Knowledge of medical terminology, anatomy and physiology, and ICD-10 and CPT/HCPCS code sets • Minimum 3-5 years of experience in health care billing and reimbursement analysis. • Knowledge of medical and insurance terminology. • Excellent verbal communication, telephone etiquette, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies. • Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues. • Ability to prioritize work based on criticality and re-prioritize as STAT cases are submitted • Demonstrate dependability, critical thinking, and creativity and problem-solving abilities. • Applies critical thinking skills to identify and resolve problems proactively and identify patient responsibility • Basic working knowledge of UB04 and Explanation of Benefits (EOB). • Knowledge of the Patient Access and hospital billing operations of Epic. • Outstanding organization and time management skills • Proficient computer knowledge including MS Office with ability to enter data, sort and filter excel files • High School Diploma or equivalent