Financial Clearance Specialist

The Financial Clearance Specialist serves as a patient liaison for pre-service financial clearance at Dana-Farber Cancer Institute (DFCI) and engagement throughout the patient’s financial experience. Reporting to, and under close direction of, the Access & Financial Engagement Supervisor, the Financial Clearance Specialist is responsible for managing all work related to financial clearance of new or prospective patients at DFCI and ongoing authorization for patients with out-of-network/high risk insurance plans. Working in a fast-paced, high-volume, dynamic environment, the Financial Clearance Specialist will demonstrate a strong understanding of payer coverage policies while applying appropriate payer guidelines to all aspects of out-of-network financial clearance. With guidance, the Financial Clearance Specialist will create accurate authorization requests and thorough and concise documentation, monitor requests for decision and communicate to the appropriate stakeholders, including the patient. This role requires attention to detail, the ability to multitask and think strategically, as well as a commitment to service excellence with the goal of protecting the financial interests of both patients and the Institute.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

PRIMARY DUTIES AND RESPONSIBILITIES:

With supervision, the Financial Clearance Specialist I:

• Reviews and monitors new patient daily appointment record and identifies and prioritizes patients with insurance plans that require prior authorization.
• Verifies insurance benefits, utilizing automated eligibility systems, payer portals, and/or telephone communication.
• Accurately and courteously communicates financial clearance process to patients, including a high-level benefits explanation, network status of DFCI for their plan, and authorization/ referral requirements; assists patients with resolving insurance related issues prior to initiating treatment.
• Reprioritizes work to respond to requests for clearance for clinically urgent patients and produces high quality work under time constraints.
• Monitors established patient work queues to ensure required authorization and/or referrals are obtained prior to service being rendered and within payer guidelines.
• Works with patient and/or Primary Care Physicians to complete payer-specific prior authorization request forms and applies appropriate guidelines to prior authorization requests.
• Responds to health plan-reviewed prior authorization requests that do not meet initial policy criteria. Works with the health plan to resolve issues and/or coordinate appropriate provider-to-health plan interventions (e.g., peer-to-peer discussions, letters of medical necessity, provider-initiated appeals, etc.).
• Effectively communicates with appropriate DFCI staff (e.g., New Patient Representatives, New Patient Coordinators, Established Patient Schedulers, clinical team) regarding financial clearance status.
• Maintains accurate, thorough, and complete records related to financial clearance activities to support post-claim denial workflows.
• Completes assigned work queues, projects, and other duties as directed.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

• Strong customer service and communication skills, both written and verbal.
• Strong relationship building skills and collaboration abilities.
• Solid analytical and problem-solving skills.
• Ability to prioritize work with direction within established policies and meet pre-determined deadlines in a fast-paced environment.
• Ability to work with sensitive patient information and maintain confidentiality; ability to use good judgment, tact, and sensitivity.
• Working knowledge of Epic or other hospital information systems.
• Demonstrated knowledge of third-party payer rules and regulations.
• Proficiency in Microsoft Office preferred

MINIMUM JOB QUALIFICATIONS:

Minimum Education:
High school diploma or GED, Bachelor’s Degree preferred

Minimum Experience:
2-3 years of relevant work experience, such as hospital/physician office, prior authorization, financial counseling and/or billing experience.
Other relevant experiences include, but are not limited to healthcare/business administration, training or instructional design, health insurance, medical policy review, and/or pharmacy support.