Job Description

Location: Steward Health Care
Posted Date: 5/25/2023


This position is responsible for ensuring that a patient’s visit is financially secured prior to the date of service. The role includes, but is not limited to, verifying patient insurance eligibility/ benefits, calculating patient liability estimates, securing prior authorization, providing notice of admission, obtaining referrals, and verifying medical necessity. These efforts will result in increased net revenues by reducing front-end related denial write-offs. Interactions will be conducted with providers, payers, patients, and other Steward team members to complete Financial Clearance functions.


  • Verifies eligibility and benefit information through contacting payers or by utilizing various eligibility tools, such as Experian and payer portals
  • Performs coverage discovery within Experian’s eligibility tool to identify additional insurance coverage if existing insurance on file is inactive
  • Calculates and clearly documents patient liability estimates based on patient’s verified benefit information
  • Provides payers with timely inpatient and observation Notices of Admission (NOA) as required based on payer-specific guidelines
  • Initiates prior authorization requests via payer portal on behalf of Steward Health providers for applicable service lines as required
  • Validates prior authorization has been obtained and follows-up with providers via phone as required for applicable services lines and non-Steward Health providers
  • Validates referral has been obtained and follows-up with Steward Health and non-Steward Health providers for applicable service lines as required
  • Verifies medical necessity for applicable patients and identifies instances where a Medicare Advance Beneficiary Notices of Noncoverage (ABN) is required
  • Ensures Financial Clearance (e.g., verification of eligibility/ benefits, securing prior authorization, etc.) is obtained timely prior to patient’s DOS based on service line and departmental policies
  • Escalates instances where Financial Clearance may not be obtained (e.g., unable to obtain authorization) prior to patient’s DOS to appropriate stakeholders in accordance with departmental deferral policies
  • Resolves insurance coverage and authorization information discrepancies as identified through automated quality assurance tool (Experian’s RQA)
  • Works denials related to referral, authorizations, notifications, non-coverage, and medical necessity as assigned. This includes, but is not limited to, coordinating with appropriate stakeholders to submit rebills or appeals and obtaining retro authorization when required
  • Observes privacy, safety, and security procedures, and uses equipment and materials properly
  • Works cohesively with other team members to achieve departmental goals
  • Completes assigned tasks effectively and within stipulated deadlines


  • Fluent in English required; Fluent in Spanish preferred
  • Excellent customer service and communication skills (verbal and written)
  • Displays understanding of Revenue Cycle functions, flow, and operations
  • Competent in core math skills required (determined by obtaining satisfactory score on competency exam)
  • Experience level will also be a factor in lieu of educational requirements


  1. Education: High School diploma or GED required
  2. Experience: 1-2 years’ experience in dynamic healthcare (clinic, physician, or hospital setting) or payer environment preferred
  3. Software/Hardware: Comfort with data entry using Revenue Cycle software, patient management systems, and Windows-based applications preferred; experience using Microsoft Office applications such as Excel and Word a plus

Application Instructions

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