The Financial Clearance Analyst (FCA) is responsible for conducting financial analytics into the patient's overall financial responsibility and insurance requirements as it relates to the upcoming scheduled service within the Steward Healthcare System. Comprehensive analysis will be based on the verification of the patient’s coverage, the determination of authorization and referral requirements of the payer, and the calculation of the estimated patient responsibility to include: annual deductible remaining, co-insurance calculations and co-pay requirements, if applicable. The efforts of the FCA is to assure the patient will have a clear understanding of their estimated responsibility prior to service being rendered. Authorization of service is to be fully obtained, minimizing potential issues with the payer denying the service and ultimately maximizing Steward Health Care’s revenue realization. These efforts will result in increased net revenues, reduction of bad debt and denials. Interactions will primarily be conducted with the payers, appropriate physician offices and facilities.
- Verify patients covered benefits, including authorization and referral requirements
- Calculate the expected patient responsibility; including deductible, coinsurance and copay
- Demonstrates high level of customer service and professionalism
- Serve as a subject matter expert for resolution and education
- Coordinate with the respective insurance departments, physician offices or facilities, as appropriate, to secure an authorization
- Trend and assist in resolution of deferred visits due to lack of authorization
Required Knowledge and Skills
- Excellent communication skills, both verbal and written.
- Good interpersonal skills.
- Able to establish good customer relationships with trust and respect.
- Education: High School Diploma, Bachelor Preferred
- Experience: 5-10 years’ related experience required.
- Software/Hardware: Navigation and edit resolution through various web-based systems, ability to use Outlook email, Excel and Word.