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HonorHealth · 1 day ago

Financial Clearance Coordinator

Arizona, United States

Full-time

Hybrid

Entry Level

1+ years exp

HonorHealth is one of Arizona’s largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area. The Financial Clearance Coordinator plays a crucial role in performing financial clearance functions for hospital ancillary outpatient appointments, ensuring proper insurance benefits and prior authorizations are obtained to minimize denials and support the organization's financial goals.

Health Care

Responsibilities

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

Provides results of benefits, eligibility, prior authorization, and medical necessity to patients, applicable hospital ancillary department staff, and/or referring physicians, when needed, requested, or required

Answers in-bound and conducts out-bound calls from/to patients, referring physicians' offices, and insurance plans, ancillary departments, and other individuals regarding an HonorHealth patient, or related inquiries

Quickly and professionally responds to concerns from patients, staff, and others involved in patient's care while maintaining a respectful demeanor

Adheres to all HonorHealth, Pre-Services and Patient Access policies and procedures

Communicates clearly, effectively, and respectfully in all interactions

Strictly adheres to the HonorHealth ICARE values and the Employee Standards of Conduct

Timely documents all new or updated patient and insurance plan information obtained into EMR according to department standards

Documents all interactions and information regarding patients' scheduled appointments, benefits, eligibility, and prior authorization in EMR according to department standards

Facilitates problem-solving with ancillary departments, providers, referral soures, or patients, as needed

Assists in the maintenance, communication, and documentation of changing/updating payor information specific to coordination of patient needs, prior authorization, benefits, and medical necessity

Qualification

Prior authorization managementInsurance eligibility verificationMedical necessity interpretationHealthcare experienceTyping speedCommunication skillsProblem-solving skills

Required

High School Diploma or GED

Basic knowledge of health insurance plans and requirements; knowledge of hospital outpatient departments and services offered

Type a minimum of 45 words-per-minute

1 year in healthcare field: including medical office, insurance/front desk, medical insurance prior authorization, hospital registration, ancillary or surgical procedure scheduling, hospital business office (billing or collections), or prior experience in medical insurance company provider services or prior authorization departments