Financial Clearance Lead - Hybrid - (3243384)

Description

Wentworth-Douglass Hospital, a subsidiary of Massachusetts General Hospital, is renowned as one of the largest acute care hospitals in the Seacoast region of New Hampshire and Southern Maine.

At Wentworth-Douglass, we value people who contribute to patient-centered care that enhances community health; we recognize and reward those who share our values and transform our patients' lives. We invite you to explore opportunities, cultivate community wellness and professional growth.
Exhibits advanced competence and proficiency in the primary functions of Financial Clearance, including but not limited to Outside Orders Transcription, Pre-certification, Pre-Registration, Scheduling, Eligibility and Financial Assistance.
o Completes monthly job-shadowing and/or task coverage in at least one other primary function.
o Creates and/or maintains tools, reference guides and standard operating procedures for each role.
o Outside Orders Transcription: Able to validate orders based on RC-09 requirements, along with department protocols. Works in conjunction with Physician Practices and Ancillary Departments to obtain valid orders. Documents order information accurately and in a timely manner on the Order Tracking Spreadsheet. Moves orders to correct folder to be scheduled.
o Pre-certification: Able to verify that authorizations submitted by outside ordering facilities are approved and are for the correct date of service or coverage dates / facility / ordering provider / procedure / ICD and CPT code(s). Obtains authorizations for required outpatient diagnostics ordered by WDHS Providers following WHP Process. Documents work in appropriate system and spreadsheet. Conducts financial responsibility conversations with patients and is able to adequately explain any waivers, ABNs or related documents for all modalities managed by Financial Clearance Department.
o Pre-Registration / Scheduling: Able to accurately and timely update patient demographic and insurance information into applicable system. Completes out-going scheduling calls and works with Ancillary Departments to schedule patient appointments. Utilizes Clear Quote software, when applicable.
o Eligibility: Able to access necessary systems and lists, and identify issue in a timely manner. Proficient in the Insurance guidelines (internal) and Payer websites. Resolves issues, when able, and documents tracking spreadsheets.
o Financial Assistance: Able to process patient application in a timely manner. Comfortable conducting patient conversations. Certified in Marketplace Enrollment.
Demonstrates advanced leadership and professionalism through active participation in team initiatives.
o Acts as a liaison between the Financial Clearance Team, the Leadership Team and all other Wentworth-Douglass affiliates.
o Understands and uses appropriate verbal and non-verbal communication at all times, demonstrating respect, tact and consideration with all audiences.
o Serves as the first point of contact for the Financial Clearance team. Determines priority and urgency of each situation/question/concern, and includes the Leadership Team if/when appropriate.
o Plans and performs additional functions within the team assignments and department as directed, and participates in ongoing educational activities related to Financial Clearance.
o Seeks constructive feedback regarding his or her work performance and team-interaction, from both peers and leadership. Makes changes based on feedback provided, when appropriate.
o Works in conjunction with leadership to research and/or appeal denials related to Financial Clearance. Assist with implementation of necessary workflow changes and education materials in response to denials.
o Participates in the orientation and education of internal personnel. Assists in the maintenance of all pertinent training materials, sign off sheets and public education resources.
Utilizes a high level of organizational and administrative skills to ensure process efficiency in Financial Clearance.
o Maintains work area in a professional manner and ensures the team does the same.
o Maintains paper and electronic filing systems according to department standards.
o Efficiently utilizes and maintains the knowledge pertinent to the various computer applications and systems within the department; serves as a team resource for questions and troubleshooting.
o Assists in preparing and conducting staff meetings. Completes and distributes meeting agendas and meeting minutes.
o Troubleshoots IS related issues within Financial Clearance. Responsible for opening and tracking Helpdesk tickets and sharing relevant information with the leadership teams of potentially affected departments, especially those within Revenue Cycle. Notifies Leadership and/or IS of unresolved failures as soon as possible, and follows up in writing once resolved.
o Maintains staff attendance records and kronos exemption logs for Financial Clearance. Works in conjunction with Leadership to approve/deny time off requests, in accordance with department policy.
o Works in conjunction with leadership and peers to maintain staff coverage for planned and unplanned time off; Adjusts work schedule to accommodate the needs of the department.
o Assists leadership in ensuring that Financial Clearance is compliant with government regulations, organization policy, department expectation and functional requirements for each role through monthly reporting. Makes all relevant departments, practices and external affiliates aware of changes. Updates department documents and/or databases with changes.

Qualifications

Experience Minimum Required

• Minimum of 3 years of experience working in a healthcare clerical or insurance related field or active pursuit of a bachelor's degree.
• Ability to lead and coordinate work for groups of staff.
• Prior experience leading projects.
• Demonstrates team concepts, the ability to multitask, lead and communicate effectively.

Experience Preferred/Desired

• Previous experience in the healthcare insurance field, preferably in a hospital setting.
• Experience with financial counseling, reimbursement and collections in a healthcare setting.

Education Minimum Required

• Associates degree required.
• Knowledge of Medical terminology.

Education Preferred/Desired

• Bachelor's Degree in a financial / medical / business field of study

Special Skills Minimum Required

• The ability to multi-task in a fast paced environment.
• Present in a calm, professional manner.
• Requires the knowledge and ability to utilize various computer and on-line applications.
• Offer exemplary internal and external customer relations.
• Strong relationship building skills and effective communication skills.
• Advanced knowledge of medical terminology, insurance verification and authorization processes as it relates to Revenue Cycle.

EEO Statement Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

• The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Primary Location

: NH-Dover-WDH Broadway

Work Locations

:

Job

: Admin/Clerical/CustService-Other

Organization

: Wentworth-Douglass Hospital(WDH)

Schedule

: Full-time

Standard Hours: 40

Shift

: Day Job

Employee Status

: Regular

Recruiting Department: WDH Revenue Management

Job Posting

: May 4, 2023