Lead Financial Clearance Specialist - Remote

Exemption Status:

Schedule Details:

Scheduled Hours:

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This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:

1. Distributes and monitors the flow of work for an assigned group of employees. Provides training and technical assistance to employees within the assigned work area
2. Serves as a lead in implementing new or revised systems and procedures. Performs basic trouble -shooting and provides feedback on process improvements.
3. Performs a variety of complex duties utilizing advanced insurance and payor knowledge. This includes the financial clearance of patients for all inpatient admissions, surgical procedures, ambulatory/outpatient visits, tests and ancillary services.
4. Works the referrals work queue and verifies that all authorizations and pre-certifications are in place prior to services being rendered and align with provided CPT and ICD-10 codes. Investigates all elective same day surgeries and inpatient admissions for referral and/or authorization requirements.
5. Verifies insurance eligibility utilizing available technologies, payor websites, or by phone contact with third party payors.
6. Verifies patient insurance coverages using real time eligibility or batch processing as appropriate.
7. Verifies that the correct insurance company name, address, plan, policy number and filing order are entered in the Epic system.
8. Work patient and payor work queues so that patient accounts are complete prior to services being rendered.
9. Complies with referral management regulations established for primary care providers.
10. Communicates with insurance companies regarding all urgent/emergent surgeries/admissions following payor guidelines.
11. Financial clearance may consist of updates and corrections to patient demographic and insurance information, verifying benefit information and obtaining prior insurance referrals and authorizations.
12. May collect patient liabilities on or prior to the date of service as appropriate.

Standard Staffing Level Responsibilities:

1. Distributes and monitors the flow of work for an assigned group of employees. Provides training and technical assistance to employees within the assigned work area. Assists supervisor in assuring that assigned employees are provided with appropriate resources, materials, and methods. Provides recommendations to manager or supervisor for the most efficient utilization of assigned personnel. Relays work instruction from the supervisor. Provides direction, guidance and leadership in the absence of the supervisor.
2. Complies with established departmental policies, procedures and objectives.
3. Attends variety of meetings, conferences, seminars as required or directed.
4. Demonstrates use of Quality Improvement in daily operations.
5. Complies with all health and safety regulations and requirements.
6. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
7. Maintains, regular, reliable, and predictable attendance.
8. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:
Required:
1. High School Diploma.

Preferred:
1. Associate Degree in Business or Healthcare related field.

Experience/Skills:
Required:
1. Minimum of 3 years insurance verification and/or authorization experience.
2. Minimum 1-year experience as a Financial Clearance Rep in good standing. (no documented warnings within 6 months).
3. English speaking, reading and writing skills.
4. Strong oral and written communication and customer service skills.
5. Ability to use specialized applications software and computers systems for patient registration and scheduling.
6. Demonstrated knowledge of medical terminology.

Preferred:
1. Bilingual.

Unless certification is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements.

Department-specific competencies, including age-specific competencies, and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with the position incumbents.

III. Physical Demands and Environmental Conditions:

Work is considered sedentary. Position requires work indoors in a normal office environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.