"Financial Clearance Specialist - Cancer Center"

The Financial Clearance Specialist is responsible for ensuring that payers are prepared to reimburse Stony Brook University Hospital Cancer Services for scheduled services in accordance with the payer-provider contracts. When physicians and clinicians make care decisions, the Financial Clearance Specialist is aware of how a patient's benefits fit into the care plan and keeps patients and physicians informed of such, as they seek to obtain authorizations from payers.

Duties of a Financial Clearance Specialist may include the following but are not limited to:

• Obtains the financial clearance of transplant, chemotherapy, immunotherapy, oral chemo, radiology, oncology-related procedures and other services in high-pressure situations as required.
• Must utilize an understanding of ICD-10, CPT, HCPCS/JCodes, and comprehension of chemotherapy, immunotherapy cycle length, dose and frequency.
• Maintain a proficient understanding of third-party payer regulations and guidelines for these particular service lines, including a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that oncology patients require.
• Performs insurance verification, and validation of medical necessity for certain services.
• Contacts insurance companies through online portal, phone, or fax to initiate authorization, obtain insurance benefits, eligibility, medical necessity, and/or authorization information.
• Maintains a close working relationship with clinical partners and/or ancillary departments to ensure continual open communication between clinical, ancillary and all Revenue Cycle departments.
• May contact physicians or their staff to facilitate the sending of clinical information in support of the authorization to the payor, as assigned.
• Researches additional or alternative resources for non-covered services to prevent payment denials.
• Responsible for communicating to service line clinical partners in situations where rescheduling is necessary due to lack of authorization and/or limited benefits.
• Confirm and document all financial clearance information in the patient's EMR including, prior authorization verification number, effective start and end dates, and the number of units approved.
• Determine benefit and coverage levels and connects patients with Financial Navigators for resources as needed.
• Works closely with Patient Accounting, and other key stakeholders in the revenue cycle to ensure all pertinent patient and insurance information is on file for clinical submission and billing.

Training for this role will be FULLY ON SITE for an estimated 3 months.

Required Qualifications: Bachelor's degree and at least 2 years' experience handling complex insurance authorization investigations with a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology or, in lieu of Bachelor's degree, an Associate's degree and at least 4 years' experience handling complex insurance authorization investigations, and a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology. Proficient with PCs and Microsoft Office applications. Experience with direct clinical and patient interaction. Excellent written and communication skills. Exemplary customer service orientation, positive attitude and demeanor. Strong organizational and time management skills. Ability to work independently. Please Note: Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.

Preferred Qualifications: Healthcare or insurance industry experience. Experience with Medicare, Social Security and/or Medicaid systems. Bilingual.

Special Notes: Resume/CV should be included with the online application.

Anticipated Pay Range: The salary range (or hiring range) for this position is $54,344 - $66,244 / year.