Patient Financial Clearance Specialist

Description

Full-time | On-site | Gold Beach, OR | Shift Schedule: 5x8s

Compensation Range: $23.58 - $35.67.

• Compensation is based on experience, with a range reflecting entry-level candidates through those with 15+ years of experience. Eligible positions may also qualify for additional compensation with applicable shift, weekend, certification, or other differentials.

• Licensed Positions: NOC Shift (7:00 PM–7:00 AM): +$3.50/hour. | Weekend Shift (12:00 AM Saturday–11:59 PM Sunday): +$3.00/hour.
• Non-Licensed Positions: NOC Shift (7:00 PM–7:00 AM): +$3.00/hour. | Weekend Shift (12:00 AM Saturday–11:59 PM Sunday): +$2.00/hour.

Under the direct supervision of the Business Office Manager, the Patient Financial Clearance Specialist coordinates financial clearance for infusion and related services. This position works collaboratively with patients, providers, insurance carriers, Pharmacy, Nursing, Scheduling, Registration, Coding, and Patient Financial Services to verify insurance eligibility and benefits, obtain prior authorizations and referrals, address medical necessity requirements, and identify financial or coverage barriers that could delay care. The Specialist also provides financial counseling, assists patients with financial assistance and funding resources, and supports denial prevention and timely reimbursement while maintaining compliance with HIPAA, regulatory requirements, and Curry Health Network policies.

Essential Functions

Coordinates insurance eligibility verification, benefit review, pre-certification, prior authorization, referrals, and medical necessity requirements for infusion and related services.

Reviews treatment plans and schedules to ensure financial clearance is completed prior to treatment whenever possible and identifies or escalates barriers that may delay patient care.

Provides financial counseling to patients regarding insurance coverage, anticipated financial responsibility, payment options, and available financial assistance programs.

Assists patients with financial assistance resources, including hospital charity care, state and federal programs, manufacturer assistance, pharmaceutical grants, free-drug programs, and other available funding options.

Monitors authorization status, payer requirements, outstanding documentation, and related account activity; follows up on pending, denied, or delayed items and assists with denial resolution as needed.

Coordinates with providers, Pharmacy, Nursing, Scheduling, Registration, Coding, Patient Financial Services, insurance carriers, and other departments to support timely patient care and accurate reimbursement.

Maintains accurate documentation and utilizes electronic medical records, payer portals, work queues, and other systems in compliance with HIPAA, regulatory requirements, and Curry Health Network policies.

Performs other duties as assigned or requested to support the overall needs of the department and in accordance with Curry Health Network’s Mission, Vision and Shared Values.

SHARED VALUES

Service: We serve with compassion and understanding.

Teamwork: We are one team – each one of us makes a difference.

Curiosity: We promote learning.

Integrity: We live by honesty, trust, and doing the right thing by our organizational values.

Minimum Job Requirements

Education & Experience

• High school diploma or equivalent required.
• Associate or Bachelor’s degree in a related field preferred.
• Minimum two (2) years of experience in Patient Financial Services, healthcare revenue cycle, insurance authorization, or a related healthcare environment preferred.

• Working knowledge of commercial insurance, Medicare, Medicaid, prior authorization, medical necessity, and patient financial responsibility.
• Strong communication, interpersonal, organizational, analytical, and customer service skills.
• Ability to work collaboratively with patients, clinical teams, payers, and revenue cycle departments.
• Computer proficiency, including Microsoft Word, Outlook, and Excel, electronic medical records, payer portals, and related healthcare systems.
• Knowledge of HIPAA privacy and security requirements and the ability to maintain confidentiality of Protected Health Information.

Physical Demands

On-the-job Time Is Spent In The Following Physical Activities

None of the time: Taste or Smell

Up to 1/3 of the time: Sit, Walk, Stand

From 1/3 to 1/2 of the time: None

Up 2/3 of the time and more: Stand, Talk or Hear, Use Hands, Reach w/hands & arms, Push or pull, Stoop, Kneel, crawl

This job requires that weight be lifted, or force be exerted as follows:

None of the time: More than 25 pounds

Up to 1/3 of the time: Up to 10 pounds

From 1/3 to 1/2 of the time: None

Up to 2/3 of the time and more: None

This Job Has Special Vision Requirements As Follows

Close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Work Environment

This Job Requires Exposure To The Following Environmental Conditions

None of the time: Extreme heat/cold; Wet/humid; near moving mechanical parts; fumes/airborne particles; work with explosives; vibration; outdoor weather, risk of electrical shock; risk of radiation; toxic/caustic chemicals

Up to 1/3 of the time: None

From 1/3 to 1/2 of the time: None

The typical noise level for the work environment is: Moderate Noise

Hearing requirements: ability to hear alarms on equipment, patient call and instructions.

This Job Requires The Following Repetitive Motion Actions

From 1 – 2 hours per day: None

From 3 – 4 hours per day: None

From 5 – 6 hours per day: Fine Dexterity

From 7+ hours per day: Repetitive use of hands and simple/light grasping

Employee Signature: ___________________________________ Date: ­­­­­­­­­­­______________

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required. Duties and responsibilities may be modified at any time to meet the needs of the organization.