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SalaryEyeCare Partners is the nation's leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit www.eyecare-partners.com.
Position Overview:
The Financial Clearance Specialist serves as the pre-service point of contact for patient to obtain all necessary information to register and financially clear patients prior to date of service. This role directly impacts the patient experience by serving as the customer service point of contact pre-service and demonstrating knowledge of all ECP service offerings. The Financial Clearance Specialist will be responsible for pre-registration, insurance verification, price estimation, and pre-service patient liability collections.
Essential Duties and Responsibilities:The following are general responsibilities associated with the job and are listed in order of greatest to least amount of time spent on the duties.
- Verify the patient's insurance using RTE or by contacting the payor directly via the payor's website or phone call
- Verify negative batch or RTE responses by contacting the payor directly via the payor website or phone call
- Obtain accurate and complete information regarding patient benefits, coverage and eligibility including effective date, coverage limits and in-network status, and out of pocket patient amounts
- Notify and collect patient deposit requirements and financial obligations in advance of rendering services
- Work exceptions to resolve outstanding eligibility issues including contacting patient to ensuring financial clearance prior to appointment
- Collaborate with the Financial Counseling department, understanding state policies, and working to improve the ability to correctly identify true self-pay patients or those patients in need of financial counseling
- Follow appropriate escalation procedures related to financial clearance not obtained with cross functional teams – Front Desk, Providers, Admin, etc.
- Achieves key performance indicators requisite to the success of the position include:
- 95% of patients financially cleared prior to appointment
- Accounts Financially Cleared / Day – 60 per team member
- Days out financially cleared – 7 days
- 90% of available co-pays collected prior to appointment
- Patients pre-registered in 8-10 minutes
- Expected dollars collected vs actual dollars collected
Education and Experience: The minimum level of education and experience required to perform the job at a satisfactory level.
- High school diploma or equivalent required
- Associate degree or equivalent education/experience preferred
- 2+ years' experience within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling, financial clearance and/or customer service activities
Knowledge, Skills, and Abilities: The minimum level of knowledge, skills, and abilities to perform the job at a satisfactory level.
- Demonstrates understanding of business and how actions contribute to company performance.
- Demonstrates excellent customer service skills
- Comprehensive understanding of insurance verification, contract benefits, and medical terminology
- Strong data entry skills
- Excellent verbal, written, and social skills
- Extensive knowledge of PM system, Microsoft Office, and other tools as it relates to financial clearance
- Excellent time management skills and the ability to manage frequent telephone patient contacts while effective maintaining and documenting data in the patient registration systems.
- Ability to work in multiple computer systems, such as patient registration/accounting systems, document imaging, scanning, payment posting, proprietary payer websites and data quality monitoring, both accurately and efficiently.
- Ability to handle multiple tasks with excellent problem-solving skills.
- Ability to utilize multiple modes of communication (e.g. phone, fax, patient portal, e-mail, physician portal, mail, etc.) in a professional, accurate, efficient and courteous manner
- Well organized with the ability to maintain accuracy and confidentiality.
Decision Making: Common decisions made in the job and the level of review or autonomy needed to finalize such decisions.
- Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements.
- May make recommendations regarding policies associated with the job's purpose and essential responsibilities.
Work Environment: Environmental or atmospheric conditions commonly associated with the performance of the functions of this job.
- General office conditions.
Physical Requirements: Activities that are commonly associated with the performance of the functions of this job. The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
- While performing the duties of this job, the employee is regularly required to talk and hear. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must frequently lift and/or move up to 10 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
- Regular attendance is a necessary and essential function.
