The Financial Clearance Associate is responsible for creating a positive patient experience by accurately and efficiently handling the day-to-day operations relating to financial clearance activities. This includes adherence to the department's policies and procedures related to the verification of eligibility/benefits, pre-authorization requirements, available payment options, financial counseling and other identified financial clearance related duties. The Associate will work under the guidanc... more details
Mission 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 Associate is responsible for creating a positive patient experience by accurately and efficiently handling the day-to-day operations relating to financial clearance activities.This includes adherence to the department’s policies and procedures related to the verification of eligibility/benefits, pre-authorization requirements, available payment options, financial counseling and other identified financial clearance related duties.The Associate will work under the guidance of the Financial Clearance Supervisor and will be responsible for timely escalating financial clearance issues to the Supervisor or the Manager for resolution.
Major Work Activities
1.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
2.Work collaboratively with Patient Access to document updated and/or corrected insurance information into the system in accordance with applicable department policies and procedures
3.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
4.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 on-line web portals and tools, when available.Accurately document all reference and pre-authorization numbers, along with payor contact information, into electronic health record
5.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
6.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
7.Complete and timely submit all documents (PFA, COBRA, etc,) requiring Supervisor approval for financial clearance
8.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
9.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
10.Answer emails and phone calls in a timely manner, and respond to voicemails and in-basket messages within one business day
11.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
12.Seeks to improve job performance and personal growth by participating in available educational, training and mentoring opportunities
13.Perform all other duties as assigned
Required Education:
High school diploma or equivalent.
Required Experience:
Three years experience in healthcare, insurance, customer service, hospitality, business, or related field. With preferred degree, one year of required experience.
Preferred Experience/Skills:
Minimum of 5 years medical office experience, background in insurance verification/insurance coverage, authorizations for inpatient/outpatient services, EPIC experience, cost estimate creation, collections and financial counseling.
Other Requirements:
Must pass pre-employment skills test as required and administered by Human Resources.
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
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