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Financial Clearance Specialist
Children's National Health System | Silver Spring, Maryland
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Job Description


 Minimum Education
Associate's Degree

Specific Requirements and Preferences
Associate or Bachelor Degree in a health related or business related field.

Minimum Work Experience
4 Year(s)

Specific Requirements and Preferences
At least 4 years of healthcare experience in Business Operations, Patient Access and Revenue Cycle. Prior auditing experience and root cause analysis. Proficient in Microsoft office products.

Required Skills/Knowledge
Superior customer service skills and professional etiquette. Strong verbal, interpersonal, and telephone skills. Experience in healthcare setting and computer knowledge necessary. Attention to detail and ability to multi-task in complex situations. Demonstrated ability to solve problems independently or as part of a team. Knowledge of and compliance with confidentiality guidelines and CNMC policies and procedures. Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers. Previous experience with Cerner, Passport, or other related software programs and EMRs preferred. Bilingual abilities preferred. Successful completion all Patient Access training assessments required and meet minimum typing requirements. 

Functional Accountabilities

Revenue Cycle and Integrity
  1. Run and identify areas of review and complete monthly audits and all service areas.
  2. Complete data deep dives and identify trends, root causes, corrective actions and present outcomes to leadership via monthly meeting, presentations and reports.
  3. Audit authorization performance by registration staff across the enterprise and communicate findings to the appropriate department leaders; collaborate with individual departments - Compliance Department, Patient Financial Services, Case Management, and Centers of Excellence to reduce first pass denials.
  4. Review all claim denials for authorizations to identify trends, root causes, corrective actions and appeal options. Write appeal letters to payers to obtain payment for services. Based on outcomes complete claims recovery with payors and business operations to increase the organizations financial strength.
  5. Audit prices estimations to ensure the control and validity process.
  6. Track monthly clearance volume and outcomes and provide to leadership to support monitoring RIO.
Financial Clearance
  1. Follow established department policies too completely and accurately pre-register patients, verify insurance eligibility and benefits, validate pre-certification or referral status, and collect patient responsibility amounts for services provided throughout the health system meeting departmental standards for productivity and quality.
  2. Establish contact with patients via inbound and outbound calls and access department work queues to pre-register patients for future dates of service.
  3. Verify insurance eligibility and benefits by utilizing integrated real-time eligibility tool, payer websites, and telephone calls to payers; document payer verification responses in designated fields within the registration pathway; compare the primary care physician (PCP) information indicated by the insurance verification response to the location of the primary care office visit, if applicable; contact the patient/family and provide guidance for resolution of PCP discrepancies or mismatches.
  4. Validate authorization status, if applicable, and communicate with ordering physicians’ offices to obtain authorization information; document authorization status in designated field within the registration pathway.
  5. Work collaboratively with all departments/services of the Children’s National Medical Center to ensure that all scheduled patients have undergone financial clearance prior to service.
Staff Developments and Special Projects
  1. Based on outcomes and trends provide training and site visit to aid to staff education and productivity.
  2. Develop training tools and materials accordingly and monitor their use and compliance.
  3. Build standard processes and to increase TOS collections and decrease first pass denials.
  4. Participate and take lead on special projects that impact revenue cycle.
  5. Research revenue cycle related outcomes to support business decisions.
Pre-Service / Point of Service Collections
  1. Interpret insurance verification information to estimate patient financial responsibility amounts for scheduled services and inpatient stays.
  2. Analyze insurance plan benefit information and utilize price estimation technology to calculate patient responsibility amounts for scheduled services and inpatient stays, include co-insurance and deductibles.
  3. Communicate patient financial responsibility amounts and initiate the point of service (POS) collections process.
  4. Identify patients requiring payment assistance options and facilitate communication between patients and CNMC Financial Information Center (FIC).
  5. Provide data to departments in an effort to increase TOS collections.
  6. Review eligibility system usage compliance and communicate outcomes accordingly.
Non-Essential Function
  1. May perform other duties as assigned.

Organizational Accountabilities (Staff)

Organizational Commitment/Identification
  1. Partner in the mission and upholds the core principles of the organization
  2. Committed to diversity and recognizes value of cultural ethnic differences
  3. Demonstrate personal and professional integrity
  4. Maintain confidentiality at all times
Customer Service
  1. Anticipate and responds to customer needs; follows up until needs are met
  1. Demonstrate collaborative and respectful behavior
  2. Partner with all team members to achieve goals
  3. Receptive to others’ ideas and opinions
Performance Improvement/Problem-solving
  1. Contribute to a positive work environment
  2. Demonstrate flexibility and willingness to change
  3. Identify opportunities to improve clinical and administrative processes
  4. Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
  1. Use resources efficiently
  2. Search for less costly ways of doing things
  1. Speak up when team members appear to exhibit unsafe behavior or performance
  2. Continuously validate and verify information needed for decision making or documentation
  3. Stop in the face of uncertainty and takes time to resolve the situation
  4. Demonstrate accurate, clear and timely verbal and written communication
  5. Actively promote safety for patients, families, visitors and co-workers
  6. Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

About Children's National Health System

Childrens National Medical Center is the only exclusive provider of pediatric care in the metropolitan Washington area and is the only freestanding childrens hospital between Philadelphia, Pittsburgh, Norfolk, and Atlanta. Serving the nations children for more than 130 years, Childrens National is a proven leader in the development and application of innovative new treatments for childhood illness and injury.

Childrens National is proudly ranked consistently among the best pediatric hospitals in America by US News & World Report.

Our Culture

Children's mission is to be preeminent in providing pediatric health care services that enhance the health and well-being of children regionally, nationally and internationally. Through leadership and innovation, Children's creates solutions to pediatric healthcare problems. Children's excels in Care, Advocacy, Research, and Education to meet the unique needs of children, adolescents and their families. Children's leadership realizes that our employees are the heart of our medical center and the soul of our mission. One of our greatest assets is the diversity of our workforce, which adds to the richness of our culture. Teamwork, dedication, and professionalism are essential values and characteristics that make our employees unique.

Childrens internationally recognized team of pediatric healthcare professionals care for more than 360,000 patients each year who come from throughout the region, nation and world. Our employees share a sense of pride and commitment to the patients and families we serve. We aspire to provide patients and their families with the highest quality of care and service in a family-centered environment. In essence, we are a team of "Great People Providing Great Care."

Nursing Students

As a nursing student, you might already be craving hands-on experience at a highly respected hospital. You may be thinking about where or with which population you want to work after graduation.

At Childrens, a world-class teaching hospital and internationally-recognized leader in pediatric health, we invite nursing students at all stages of learning to explore the real world of working in a hospital setting and experience first-hand the challenges and rewards of this career.

Internship Program

The internship program provides the novice nurse with the knowledge base and skill set needed to transition to competence in clinical nursing practice. While providing the needed skills to meet the organization goals and mission, the program provides nurses with the leadership skills to work collaboratively within a multidisciplinary team. The program bridges the gap between undergraduate education and real-life professional nursing practice, delivering state-of-the art pediatric care.

The program is offered to new graduate nurses from an accredited nursing program with a passion for children. All new graduates, with less than one-year acute care experience, are eligible to participate in the program after obtaining licensure.