Financial Clearance Specialist (Remote)

Financial Clearance Specialist (Remote)

About Us

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, MGB supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

General Overview

Under the direction of the Manager Financial Experience, the Financial Clearance Specialist is responsible for securing payment solutions for uninsured and underinsured patients to enable them to meet their financial obligations to Mass General Brigham. The incumbent serves as liaison between the patient and their insurance benefits, providing details of their estimated out of pocket liability and providing estimates of coverage. Ensures the integrity of all data collected prior to or at time of service to ensure accurate benefits information and personally collects and facilitates the accurate and timely payment for services provided by leveraging available insurance solutions. Delivers superior internal and external customer service.

Principal Duties and Responsibilities

• Use/s the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration
• Interview patients via telephone in a professional manner that results in positive patient relations and prompt reimbursement for the hospital. Perform a preliminary financial screening to determine eligibility for government assistance programs
• Serve as liaison between the patient and their insurance benefits, providing details of their estimated out of pocket liability based on their insurance coverage, copays, deductibles, and co-insurance
• Interacts with the patient and ensures their billing expectations are clear and concise prior to date of service.
• Informs patient of required documents for financial assistance applications
• Screens all self-pay patients, identifies solution(s), and facilitates patient payment and/or solution application process.
• Schedule patients for appointments with Financial Counselors at site locations upon screening for financial assistance and facilitates application
• Fields patient billing inquiries and refers to PBS staff for resolution.
• Monitors, manages, and actively follows up on active large self-pay and long length of stay accounts ensure solutions / solution modifications in place for patients and optimize ultimate payment for the hospital.
• Identifies current and prior patient responsible balances, educates patients on their financial responsibilities, and collects self-pay pre-services such as Cosmetic.
• Provides estimate of charges to customers such as patients and/or offices.
• Delivers exemplary customer service for patients in accordance with hospital expectations / guidelines.
• Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
• Updates estimate calculation to reflect changes to procedure being performed or payor coverage and informs patient of changes
• Accepts co-payments, deductibles, co-insurance, and other patient balances where applicable
• Utilizes knowledge of various payer requirements and when necessary, research any billing inquiries initiated by the patient and can provide a comprehensive and comprehendible explanation to the patient and or practice.
• Verifies patient identification, demographic information, and insurance coverage.
• Assists in registration process and update any account when necessary. Adheres to all registration policies to assure effective operations
• Other duties as assigned

Qualifications

• High School Diploma or equivalent required.
• Bachelor’s degree in related field preferred
• Certified Applications Counselor (CAC) preferred
• 3 – 5 years’ experience in hospital registration/billing office/clinic with a current working knowledge of registration, insurance, and billing requirements preferred

• Epic experience required.
• A combination of education and experience may be substituted for requirements

Skills/Abilities/Competencies

• Maintains working knowledge of private, public, and third-party payer insurance and related regulations.
• Proficient in department collection practices and concepts of third party, bad debt and free care regulations.
• Demonstrated knowledge of federal and state Medical Assistance eligibility regulations and advanced knowledge of healthcare finance.
• Knowledge of federal and state financial assistance programs.
• Time management skills and attention to detail.
• Adhere to all hospital and departmental policies and procedures.
• Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization

Mass General Brigham is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.