Authorization Specialist/Financial Clearance Analyst/FT 40 hours per week

Description

At Bristol Health, we begin each day caring today for your tomorrow. We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients, residents and families. We are committed to provide compassionate, quality care at all times and to uphold our values of Communication, Accountability, Respect and Empathy (C.A.R.E.). We are Magnet ® and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic. Use your expertise, compassion, and kindness to transform the patient experience. Make a difference. Make Bristol Health your choice.

JOB SUMMARY:

Under the direction of the Manager of Pre-Service and Financial Clearance, the Financial Clearance Analyst is responsible for the financial clearance of scheduled patient authorizations, including insurance verification, and validation of medical necessity for services. Works in coordination with
provider practices and hospital departments to ensure all scheduled services are reviewed for required authorizations and cleared in advance. The Financial Clearance Analyst will also work other revenue cycle teams to ensure proper billing requirements are met and denials are proactively addressed.

ESSENTIAL JOB FUNCTIONS:

• Handle authorization process and obtain pre-certification approvals prior to service.
• Submit pre-authorization requests and follow up with payer to ensure timely approvals
• Maintain accurate records and reports of pre-certifications request, approvals, and denials
• Work assigned worklists and submit authorization information according to payer requirements
• Follow up on authorization requests and coordinate with practices and departments according to established policies
• Collaborate with revenue cycle team and participate in monthly meetings to review payment and denial trends
• Coordinate with provider practices and hospital departments to ensure timely scheduling of patient procedures
• Respond to patient and insurance inquiries and provide Good Faith Estimates when required
• Perform post service reconciliations and denial follow up tasks
• Act as a back-up to the Financial Counselor team, supporting Notice of Admission and Financial
• Assistance activities Adhere to applicable policies and procedures, including HIPAA compliance, and state and federal regulations
• Other duties as assigned

Qualifications

KNOWLEDGE / SKILLS / ABILITIES:

• Ability to ensure quality and integrity of assigned tasks and meet given productivity standards
• Possess a patient-centric approach to answer questions and provide information in a professional manner
• Demonstrate teamwork, cooperation and collaboration within and outside the team
• Skill in effective oral, written, and interpersonal communication
• Skill in problem-solving in a variety of settings and translation of data into actionable steps
• Ability to read, understand, interpret, and analyze payer requirements
• Ability to work independently and take initiative
• Excellent customer service and communication as well as interpersonal, organizational and analytical skills
• Demonstrate initiative and ability to multi-task while working independently
• Strong organizational skills and systems aptitude

REQUIRED EDUCATION / EXPERIENCE:

• A Bachelor's degree and a minimum of (1) year of revenue cycle experience or Associates degree and a minimum of (2) years of patient access, financial clearance or financial counselor experience or High School Diploma and a minimum of (5) years of patient access, financial clearance or financial counselor experience
• Experience with payer portals and requirements preferred
• Familiarity with medical and insurance terminology
• Knowledge of payer contracts, regulations and guidelines as well as State and Federal laws relating to billing, collections, and patient access procedures

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.