[Hiring] Senior Revenue Cycle Associate - Financial Clearance @Quorum Health

Role Description

The Senior Revenue Cycle Associate, Financial Clearance position is responsible for ensuring that a patient’s visit is financially cleared prior to the date of service. This position serves as the subject matter expert and go-to resource for peers, providing guidance on complex registration, insurance, workflow, and patient financial responsibility matters. The role includes:

• Verifying patient insurance eligibility/benefits
• Calculating patient liability estimates
• Securing prior authorization
• Providing notice of admission
• Obtaining referrals
• Verifying medical necessity

These efforts will result in increased net revenues by reducing front-end related denial write-offs. Interactions will be conducted with providers, payers, patients, and hospital-based personnel. Duties are to be performed accurately and timely while providing exceptional customer service. This position is not a formal supervisory role.

Qualifications

• Proficient in typing
• General knowledge of medical terminology
• Ability to communicate effectively and professionally in English, both verbally and in writing
• Critical thinking and problem-solving skills
• High school graduate or equivalent
• One year of related experience in the medical field is preferred

Requirements

• Ensures Financial Clearance (e.g., verification of eligibility/ benefits, securing prior authorization, etc.) is obtained timely prior to the patient’s date of service based on service line and departmental policies
• Performs coverage discovery using eligibility tools to identify additional insurance coverage if existing insurance on file is inactive
• Calculates and clearly documents patient liability estimates based on patient’s verified benefit information
• Provides payers with timely inpatient and observation Notices of Admission (NOA) as required based on payer-specific guidelines
• Validates prior authorization has been obtained and follows up with providers via phone as required for applicable services lines
• Verifies medical necessity for applicable patients and identifies instances where a Medicare Advance Beneficiary Notices of Noncoverage (ABN or NONC) is required
• Escalates instances where Financial Clearance may not be obtained (e.g., unable to obtain authorization) prior to patient’s DOS to appropriate stakeholders in accordance with departmental deferral policies
• Resolves insurance coverage and authorization information discrepancies as identified through automated quality assurance tool
• Works denials related to referral, authorizations, notifications, non-coverage, and medical necessity as assigned, including coordinating with appropriate stakeholders to submit rebills or appeals and obtaining retro authorization when required
• Observes privacy, safety, and security procedures, and uses equipment and materials properly
• Possesses the ability to work within a remote call center environment, free from distractions and background noise
• Recognizes and consistently exhibits exceptional customer service as a critical factor in all duties performed

Benefits

• Competitive salary and benefits package
• Opportunities for professional development and advancement
• Supportive work environment with a collaborative team
• Comprehensive healthcare coverage
• Retirement savings plan
• Paid time off and flexible scheduling options
• Student loan repayment program