Position Highlights:

The Financial Clearance Unit Specialist is responsible for identifying the responsible party for payment of services, verifying eligibility and benefits, securing authorizations from insurance companies or finding financial alternatives for patients in order to secure the financial health of Moffitt Cancer Center. This includes analyzing, identifying and resolving barriers, monitoring assigned worklists throughout the day, accurate creation and allocation of policies, accurate submission of clinical information, prompt and effective follow up, exhausting all resources for clearance, understanding of automation processes, effective communication with patients and clinical teams to ensure patients can timely receive the care needed and the center is reimbursed for services rendered.

Responsibilities:

• Requesting authorizations for all types of services provided at Moffitt Cancer Center through all health insurance payors by form of website portal navigation, physical faxed requests to health plans/PCP offices, and manual phone calls to health plans/PCP offices. - Authorization requests demand/entail navigation through clinical records/documentation and a basic comprehension of clinicals/medical oncology within a clinical chart
• Basic knowledge of coding (both diagnosis and service) for proper submissions of authorization
• Provide clinical information to the health plans or physician’s offices by answering clinical questions online or over the phone, or providing specific clinical documentation via fax for review
• Reading/understanding clinical orders from providers to submit authorizations for the proper services
• Navigation through appointment center tool to advise on what is needed for approaching services
• Navigation of certain software’s for legal/HIPPA compliance i.e. Trace, pixcert, Soarian, XR (Cerner)
• Thorough documentation of cases for optimal clarity and uniformity amongst the department
• Calling health insurances, primary physicians offices, and patients/families to relay/receive information regarding authorizations/coverage
• Communication between other departments including Clinical Trial Coordinators, Patient Appointment Center and Business Office to aid in patient’s needs for coverage
• Submitting appeals and reconsiderations via phone calls or fax when situation permits for better/extended attempt at coverage for patients
• Calling/notifying patients when coverage cannot be obtained
• Managing assigned worklists to ensure patients services are covered in ample amount of time before appointment date
• Navigation of worklists including data input, documentation, filtering and working in conjunction with RPA (automation)
• Maintaining a steady workflow to ensure the assigned worklists do not fall behind and is ever current
• Follow up on all encounters within the worklists by calling health plans, checking submissions via web, and reviewing the fax box for vital information regarding case approvals, denials
• Balancing one or more worklists at any given time by prioritizing with time management skills to ensure patients are granted approval in a timely manner
• Complete specific metrics of encounters on the worklists daily to ensure timely patient care
• Provide error free work on assigned worklist to minimize any loss of revenue for the organization
• Works all worklists throughout each day, every day
• Responds to correspondence received from payer and/or patients
• Ensures proper multi-tasking to manage worklists assignments between calls
• Ensures collection and documentation are correct and appropriate action taken place is documented
• Meets or exceeds established productivity goals; notifies Supervisor, when necessary, of issues preventing achievement of such goal(s) per departmental Operational Guidelines
• Demonstrates proactiveness when not meeting Productivity Goals based on Hours Worked by reaching out for re-education/game plan to get back on track
• Meets or exceeds monthly QA score per department guidelines.
• Accepts feedback from supervisor each month
• Follows procedures outlined in operational guidelines and score cards

Credentials and Experience:

• Minimum of six (6) months of experience as a Financial Clearance Specialist I or II and meet all requirements of Financial Clearance Unit Promotional Program for Level III
• Healthcare Finance Management Association (HFMA) Certified Revenue Cycle Representative (CRCR) certification *Must obtain within 12 months from date of hire/transfer. (Certification will be tracked by the Financial Clearance Unit Department
  • * In lieu of six (6) months of experience as a Financial Clearance Specialist I or II, (3) years recent patient registration, insurance verification and/or insurance pre-certification/authorization with a healthcare provider or insurance company