Long Island Community Hospital has served this richly diverse region as a patient-first community hospital for more than 60 years. As Long Island's only independent community hospital, we are 100% committed to becoming the community's healthcare provider of choice with our greatly enhanced services including the Knapp Cardiac Care Center, our highly-advanced heart disease diagnosis and treatment facility, our new modern surgical pavilion, our unique ER approach, and our high-touch services including women's imaging, sleep laboratory and orthopedics and more. These services are delivered with the highest level of compassion by our LI Community Hospital staff - Long Islanders with an unmistakable mix of courage and heart who care about the people right here in our community and whose sole purpose is to provide personalized comfort. For more information, go to licommunityhospital.org, and interact with us on LinkedIn, Glassdoor, Indeed, Facebook, Twitter, YouTube and Instagram.
Position Summary:
We have an exciting opportunity to join our team as a Financial Clearance Associate - Full Time Days 9AM-5PM - Customer Svc/Ins Verification - FIN-Insuran.
In this role, the successful candidate Under the general direction of the RCO Director and the assigned RCO Associate Director/Sr Manager/Manager/ Supervisor, the RCO Financial Clearance Associate (FCA) is responsible for performing accurate and timely insurance clearance functions pre and post service to ensure maximum hospital reimbursement and mitigate insurance denials. Health system responsibilities for the FCA include, but are not limited to: 1) verifying insurance eligibility and determining patients insurance coverage and insurance authorization requirements, 2) obtaining and documenting pre-authorizations and pre-certifications, 3) verifying coverage levels, 4) utilizing the Epic Estimate tool to calculate
patients estimated hospital financial responsibility and ensuring OOP amounts are communicated to the patient pre-service, 5) working cases timely and efficiently from the Epic Work Queues/DAR as assigned, 6) collecting pre-service time of payments and 7) providing exceptional customer service to both internal and external stakeholders and facilitating RCO and patient financial needs. Supports and demonstrates the Philosophy/Mission of LICH in the performance of duties and representation.
Job Responsibilities:
This position is responsible and accountable for the timely and accurate insurance clearance of pre and post inpatient and outpatient accounts from Epic Work Queues as assigned. Performs insurance benefits verification to confirm eligibility for scheduled or prospective services. Reviews for appropriate coordination of benefit and identifies discrepancies prior to clearance. Determines insurance authorization requirements for services scheduled or received. Ensures all scheduled services are authorized and appropriate notification and/or referral is obtained prior to the date of service to ensure payment for services. Ensures clear and timely documentation of all insurance clearance activities and outcomes, including authorization information in Epic. Performs all required follow-up to secure authorization pre-service, including follow-up with providers’ offices, scheduling departments and insurance companies. Performs medical necessity review for applicable services to ensure diagnosis is covered under insurance carrier clinical bulletin policy for outpatient appointments as scheduled. Determines patients’ benefit level based on in-network or out-of-network benefits. Identifies non-par plan status and follows appropriate out of network workflow based on service and payor type. Calculates and communicates patients’ estimated out of pocket hospital financial responsibility pre-service for scheduled or prospective services utilizing the Epic Estimator tool or International Calculator. Understands performance measures and is accountable for meeting monthly target goals as determined based on service and payer. Exercises skill in prioritizing assignments in order to complete work in a timely manner when there are changes in workload, assignments, and pressures of deadlines, competitive requirements and/or a heavy workload. Demonstrates optimal customer service skills when interfacing with patients, patients’ families,physicians, physician office staff, and hospital colleagues.
Demonstrates excellent communication skills; uses appropriate vocabulary and grammar when obtaining and conveying information to physicians, nurses and staff at various levels; in person, over the phone, in writing and in electronically sent messages. Works collaboratively with and acts as a liaison with a variety of internal departments within NYULH, external business partners, external departments, and NYULH’s contracted payers. Works independently, takesinitiative, and escalates to leadership appropriately. Responsible for answering and redirecting phone calls as needed and responding to emails timely. Adhere to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required trainings, and other Hospital mandated activities. Perform other duties as assigned.
Minimum Qualifications:
To qualify you must have a High School Diploma and 1-year experience in patient accounts or related field or an equivalent combination of education and experience.
Strong knowledge of front-endhospital, medical office, patient access, revenue cycle and /or practice operations.
Knowledge of medical andinsurance terminology. Knowledge of insurance benefit verification tools including payor portals, RTE, etc. Ability to perform with accuracy and attentionto detail for meeting payer-imposed
deadlines on a dailybasis. Ability to compose andedit logical, detailed, comprehensive andgrammatically correct correspondence. Ability to communicate effectively witha wide variety of personnel including patients, families, physicians andstaff. Experience andcompetency with varied computer hardware and software, including
registration and billing systems, wordprocessing, spreadsheet, database, scheduling, communications. Ability to handle matters of highly confidential and sensitive nature. Ability to recognize andidentify problems, recognize implications andpropose alternative solutions. Skill inprioritizing assignments to complete work in a timely
manner. Skill in working independently andin following through on assignments with minimal direction.
Preferred Qualifications:
Associates degree plus 2-3 years of experience in hospital admissions, patient accounts or medical records or in related field. Epic experience.
Qualified candidates must be able to effectively communicate with all levels of the organization.
Long Island Community Hospital provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
Long Island Community Hospital is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online.
If you wish to view Long Island Community Hospital's EEO policies, please click here. Please click here to view the Federal "EEO is the law" poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information.
Long Island Community Hospital provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $52,942.50 - $52,942.50 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
To view the Pay Transparency Notice, please click here