Coordinator - Financial Clearance

Primary City/State: Network Support Services Building 1 Category: Finance Shift: Day Department: Pre-Registration Great care starts with great people. (Like you.) At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.

Responsibilities

Job Summary Under Pre-Services/Pre-Registration Leadership, this position performs financial clearance functions for hospital ancillary outpatient appointments. The position is responsible for denial prevention and protecting and contributing to the organization's financial goals by obtaining and documenting patients' insurance benefits and eligibility status, initiating and securing prior authorization with payers, and by validating, analyzing, and accurately interpreting medical necessity results by reviewing payer specific medical policies or criteria, utilizing the web-based medical necessity software.

The position is responsible to create Commercial Waivers and Medicare ABN's, when necessary, and contacts patients to inform them of their insurance benefits and authorization status applicable to their scheduled service(s), or to discuss any issues with eligibility, medical necessity, or prior authorization. The position works closely with referring physician offices and the hospital departments where patient is scheduled, to minimize denials and insure authorizations are obtained in a timely manner.

Detailed, accurate, and timely documentation of applicable insurance benefits, eligibility, prior authorization, interactions, and other payer or patient information into patients' EMR is required according to department standards. This is a work-from-home position that may require staff to commute to NSSC for staff meetings, staff training, and occasional one-on-one meetings with Supervisor. Occasional overtime work may be required.

Essential Functions

Performs tasks related to the management of prior authorization, insurance eligibility and benefits, and medical necessity for patients served by hospital ancillary departments. Obtains insurance eligibility and benefits utilizing Real Time Eligibility (RTE), payor websites, or when necessary, calling payor. Reviews payer specific medical policies/criteria when necessary to interpret medical necessity results using the web-based medical necessity tool. When necessary, reviews and/or requests clinical documentation from referring physician, to substantiate medical necessity and submits to payor with request for prior authorization.

Requests and secures prior authorization for scheduled ancillary services and validates and interprets medical necessity prior to date of service and according to department standards…

Read the full posting