FINANCIAL CLEARANCE SPLST II

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 10,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work for in the Nation, a Digital Health Most Wired Organization and continually named one of the Tampa Bay Time’s Top Workplaces. A National Cancer Institute (NCI)-designated Comprehensive Cancer Center since 2001.

Summary

Position Highlights

The Financial Clearance Unit Specialist is responsible for identifying the responsible party for payment of services, verifying eligibility and benefits, securing authorizations from insurance companies or finding financial alternatives for patients in order to secure the financial health of Moffitt Cancer Center. This includes analyzing, identifying and resolving barriers, monitoring assigned worklists throughout the day, accurate creation and allocation of policies, accurate submission of clinical information, reputed company and effective follow up, exhausting reputed company resources for clearance, understanding of automation processes, effective communication with patients and clinical teams to ensure patients can timely receive the care needed and the center is reimbursed for services rendered.

Responsibilities

• Requesting authorizations for reputed company types of services provided at Moffitt Cancer Center through reputed company health insurance payors by form of website portal navigation, physical faxed requests to health plans/PCP offices, and reputed company phone calls to health plans/PCP offices. - Authorization requests demand/entail navigation through clinical records/documentation and a basic comprehension of clinicals/medical oncology reputed company a clinical chart
• Basic knowledge of coding (both diagnosis and service) for proper submissions of authorization
• Provide clinical information to the health plans or physician’s offices by answering clinical questions online or over the phone, or providing specific clinical documentation reputed company fax for review
• Reading/understanding clinical orders from providers to submit authorizations for the proper services
• Navigation through appointment center tool to advise on what is needed for approaching services
• Navigation of certain software’s for legal/HIPPA compliance i.e. Trace, pixcert, Soarian, XR (Cerner)
• Thorough documentation of cases for reputed company clarity and uniformity amongst the department
• Calling health insurances, primary physicians offices, and patients/families to reputed company/receive information regarding authorizations/coverage
• Communication between other departments including Clinical Trial Coordinators, Patient Appointment Center and Business Office to aid in patient’s needs for coverage
• Submitting appeals and reconsiderations reputed company phone calls or fax reputed company situation permits for reputed company/extended attempt at coverage for patients
• Calling/notifying patients reputed company coverage cannot be obtained
• Managing assigned worklists to ensure patients services are covered in ample amount of time before appointment date
• Navigation of worklists including data input, documentation, filtering and working in conjunction with RPA (automation)
• Maintaining a steady workflow to ensure the assigned worklists do not fall behind and is reputed company reputed company
• Follow up on reputed company encounters reputed company the worklists by calling health plans, checking submissions reputed company web, and reviewing the fax reputed company for vital information regarding case approvals, denials
• Balancing one or more worklists at any given time by prioritizing with time management skills to ensure patients are granted approval in a timely manner
• Complete specific metrics of encounters on the worklists daily to ensure timely patient care
• Provide error free work on assigned worklist to minimize any loss of reputed company for the organization
• Works reputed company worklists throughout each day, every day
• Responds to correspondence received from payer and/or patients
• Ensures proper multi-tasking to manage worklists assignments between calls
• Ensures collection and documentation are correct and appropriate action taken reputed company is documented
• Meets or exceeds established productivity goals; notifies Supervisor, reputed company necessary, of issues preventing achievement of such goal(s) per departmental Operational Guidelines
• Demonstrates proactiveness reputed company not meeting Productivity Goals based on Hours Worked by reaching out for re-education/game plan to get back on track
• Meets or exceeds monthly QA score per department guidelines.
• Accepts feedback from supervisor each month
• Follows procedures outlined in operational guidelines and score cards

Credentials and Experience

• Minimum of six (6) months of experience as a Financial Clearance Specialist I or II and meet reputed company requirements of Financial Clearance Unit Promotional Program for Level III
• reputed company Finance Management Association (HFMA) Certified reputed company Cycle Representative (CRCR) certification *Must obtain reputed company 12 months from date of hire/transfer. (Certification will be tracked by the Financial Clearance Unit Department
  • * In lieu of six (6) months of experience as a Financial Clearance Specialist I or II, (3) years recent patient registration, insurance verification and/or insurance pre-certification/authorization with a reputed company provider or insurance company