Address
Form of workMission Statement
The mission of The University of Texas MDAnderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
Summary
The Financial Clearance Coordinator will use their clinical knowledge and judgment to facilitate with the timely resolution of issues related to the Financial Clearance process, including assessment and interpretation of the patient's clinical condition, preparation of medical necessity justifications and assistance with peer to peer engagement.
Major Work Activities
Documentation/Authorization Processing:
• Obtain and document verification of patient eligibility (and applicable effective dates) using the available institutional and/or payor systems, including real-time web portals and tools, within the applicable timeframes as outlined by department policies and procedures. Promptly notify Patient Access and the patient, when eligibility information is invalid and/or cannot be verified
• Obtain and document verification of patient benefits, including information regarding the product type, in-network or out-of-network status, all applicable co-payment, deductible, and co-insurance amounts or percentages, pre-existing indicator and time period, and any lifetime or annual maximums into electronic health record in a timely manner
• Timely manage work lists for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations. Seek to obtain pre-authorization through online web portals and tools, when available. Accurately document all reference and pre-authorization numbers, along with payor contact information, into electronic health record
• Completely and accurately document conversations and communication with Patient Access, payors, third party vendors, patients, and any other representative in and outside of the institution
• Uses clinical knowledge and judgment to facilitate with obtaining pre-authorization on and provides support to the Associate when clinical input, interpretation, medical necessity justification and peer to peer engagement is needed
• For patients participating in a clinical trial, appropriately document and review with patients and the payors services being covered by the clinical trial sponsor and those designated for coverage under the patient's insurance
• Perform all other duties as assigned
Customer Collaboration:
• Provides financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts dues, provide information regarding available payment plan options, and provide information regarding patient financial assistance opportunities when applicable. Financial counseling also includes reviewing ABN, MSPQ, account review and any other barriers to Financial Clearance with patients as needed
• Work collaboratively with Patient Access to document updated and/ or corrected insurance information into the system in accordance with applicable department policies and procedures - Answer emails and phone calls in a timely manner, and respond to voicemails and in-basket messages within one business day
• Conducts all Financial Clearance activities in a courteous and professional manner and maintains a positive working relationship with patients, physicians, payors, third party vendors and any other identified business partners
Taking Initiative
• Promptly escalate any issues with Financial Clearance and/or counseling to the Financial Clearance Supervisor or seek assistance as appropriate from the Financial Clearance Coordinator, when needed
• Complete and timely submit all documents (PFA, COBRA, etc,) requiring Supervisor approval for Financial Clearance
• Seeks to improve job performance and personal growth by participating in available educational, training and mentoring opportunities
• Stays current with all appropriate clinical documentation and publications
Required Education:
Graduation from an accredited school of nursing.
Required Experience:
Two years experience in nursing or one year related nursing experience in utilization review, insurance, case management, or medical clearance. Current State of Texas Professional Nursing license (RN). Basic Life Support (BLS) or Cardiopulmonary Resuscitation (CPR) certification.
Preferred Experience/Skills:
Insurance authorization experience, research experience, epic navigation.
Preferred Certification:
American Heart Association Basic Life Support (BLS), ACLS (Advanced Cardiac Life Support) or PALS (Pediatric Advanced Life Support) certification as required by patient care area.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
The mission of The University of Texas MDAnderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
Summary
The Financial Clearance Coordinator will use their clinical knowledge and judgment to facilitate with the timely resolution of issues related to the Financial Clearance process, including assessment and interpretation of the patient's clinical condition, preparation of medical necessity justifications and assistance with peer to peer engagement.
Major Work Activities
Documentation/Authorization Processing:
• Obtain and document verification of patient eligibility (and applicable effective dates) using the available institutional and/or payor systems, including real-time web portals and tools, within the applicable timeframes as outlined by department policies and procedures. Promptly notify Patient Access and the patient, when eligibility information is invalid and/or cannot be verified
• Obtain and document verification of patient benefits, including information regarding the product type, in-network or out-of-network status, all applicable co-payment, deductible, and co-insurance amounts or percentages, pre-existing indicator and time period, and any lifetime or annual maximums into electronic health record in a timely manner
• Timely manage work lists for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations. Seek to obtain pre-authorization through online web portals and tools, when available. Accurately document all reference and pre-authorization numbers, along with payor contact information, into electronic health record
• Completely and accurately document conversations and communication with Patient Access, payors, third party vendors, patients, and any other representative in and outside of the institution
• Uses clinical knowledge and judgment to facilitate with obtaining pre-authorization on and provides support to the Associate when clinical input, interpretation, medical necessity justification and peer to peer engagement is needed
• For patients participating in a clinical trial, appropriately document and review with patients and the payors services being covered by the clinical trial sponsor and those designated for coverage under the patient's insurance
• Perform all other duties as assigned
Customer Collaboration:
• Provides financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts dues, provide information regarding available payment plan options, and provide information regarding patient financial assistance opportunities when applicable. Financial counseling also includes reviewing ABN, MSPQ, account review and any other barriers to Financial Clearance with patients as needed
• Work collaboratively with Patient Access to document updated and/ or corrected insurance information into the system in accordance with applicable department policies and procedures - Answer emails and phone calls in a timely manner, and respond to voicemails and in-basket messages within one business day
• Conducts all Financial Clearance activities in a courteous and professional manner and maintains a positive working relationship with patients, physicians, payors, third party vendors and any other identified business partners
Taking Initiative
• Promptly escalate any issues with Financial Clearance and/or counseling to the Financial Clearance Supervisor or seek assistance as appropriate from the Financial Clearance Coordinator, when needed
• Complete and timely submit all documents (PFA, COBRA, etc,) requiring Supervisor approval for Financial Clearance
• Seeks to improve job performance and personal growth by participating in available educational, training and mentoring opportunities
• Stays current with all appropriate clinical documentation and publications
Required Education:
Graduation from an accredited school of nursing.
Required Experience:
Two years experience in nursing or one year related nursing experience in utilization review, insurance, case management, or medical clearance. Current State of Texas Professional Nursing license (RN). Basic Life Support (BLS) or Cardiopulmonary Resuscitation (CPR) certification.
Preferred Experience/Skills:
Insurance authorization experience, research experience, epic navigation.
Preferred Certification:
American Heart Association Basic Life Support (BLS), ACLS (Advanced Cardiac Life Support) or PALS (Pediatric Advanced Life Support) certification as required by patient care area.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
