Financial Clearance Coordinator

Job Description

Job Description

Overview

The Financial Clearance coordinator is responsible for ensuring BrightSpring clients have the correct demographic, subscriber, payer identified, authorization (as provided by operations), client out of pocket documented.

Responsibilities

This position will be responsible for including but not limited to:

• Admission into EHR/EMR for assigned lines of business.
• Insurance maintenance is current and accurate, as provided by operations.
• Insurance payer knowledge and accurate completion of IVQ
  • Obtaining accurate benefit information as provided by payer.
• Identification of payer sources for our private pay or under-insured population
• Knowledgeable of programs in which BrightSpring participates.
  • Hardship Programs
  • Financial Assistance Programs
  • Health Care Credit extension
  • Ensures payment plan or program meets repayment guidelines set by BrightSpring Health Services Revenue Cycle policies.
• Ensures all CDEs(Critical Data Elements) are identified and entered correctly in EMR/HER (as applicable by line of business)
• Works closely with Operations Leaders and Revenue Cycle Leaders (specificity by line of business):
  • Communicates with Revenue Cycle leaders and Operations leaders any anticipated issues or loss of revenue due to client inability to pay or loss of eligibility
  • Understands and communicates SVP increases and decreases (applicable lines of business)
• While completing the IVQ, identifies client eligibility and insurance verification issues using various modes of identification:
  • Way Star
  • State Medicaid Website
  • Commercial Payer Website
  • Phone call to Payer
• Conduct financial conversations with clients to provide benefit explanations and analysis of deductibles, etc. to determine terms of payment for client liability within the parameters of corporate policy, when applicable.
• Ensures the playbook for Financial Clearance is accurate and up to date with all processes and programs.
• High knowledge level of commercial and government payers by line of business:
  • Out of pocket client responsibility
  • Contracted rates both in network and out of network
  • Benefit level detail understanding of above rates
• Tied to the following Key Performance Indicator to maintain and improve revenue for the organization.
  • Productivity standards completing 25 tickets/day (individual goal, depending on line of business)
  • Quality standard of 95% or greater (individual goal)
  • (Future in 2025) Rejection rate and resolution (individual goal)
  • Ticket SLA violation goal of 99% or greater (team goal)

Qualifications

• Bachelor’s Degree or equivalent of school and experience, preferred.
• Medical terminology
• Financial Clearance and collection experience.
• Front Revenue Cycle experience either in Patient Access or Patient Financial Services.
• Proven experience with conflict resolution.
• Ability to use critical thinking skills to identify and mitigate revenue risk to BrightSpring Health
• Self-directed work and excellent time management skills
• Excellent communication skills both verbal and written.
• Knowledge of government and commercial payer requirements.
• Ability to demonstrate our company Legacy standards.
• Strong attention to detail and accuracy.
• Strong time management skills and ability to meet set deadlines.
• Ability to multi-task and show flexibility as daily priorities arise and change.
• Minimum travel required.