NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. It comprises more than 200 locations throughout the New York area, including five inpatient locations, a children's hospital, three emergency rooms and a level 1 trauma center. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute designated comprehensive cancer center, and NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. At NYU Langone Health, equity, diversity, and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace diversity, inclusion, and individual skills, ideas, and knowledge. For more information, go to nyulangone.org , a nd interact with us on LinkedIn , Glassdoor , Indeed , __Facebook , Twitter , YouTube and Instagram .
Position Summary:
We have an exciting opportunity to join our team as a Financial Clearance Associate.
In this role, the successful candidate under the general direction of the RCO Director and the assigned RCO Associate Director/Sr Manager/Manager/ Supervisor, the RCO Financial Clearance Associate (FCA) is responsible for performing accurate and timely insurance clearance functions pre and post service to ensure maximum hospital reimbursement and mitigate insurance denials. Health system responsibilities for the FCA include, but are not limited to: 1) verifying insurance eligibility and determining patients insurance coverage and insurance authorization requirements, 2) obtaining and documenting pre-authorizations and pre-certifications, 3) verifying coverage levels, 4) utilizing the Epic Estimate tool to calculate patients estimated hospital financial responsibility and ensuring OOP amounts are communicated to the patient pre-service, 5) working cases timely and efficiently from the Epic Work Queues/DAR as assigned, 6) collecting pre-service time of payments and 7) providing exceptional customer service to both internal and external stakeholders and facilitating RCO and patient financial needs. Supports and demonstrates the Philosophy/Mission of NYU Langone Health in the performance of duties and representation.
Job Responsibilities:
* This position is responsible and accountable for the timely and accurate insurance clearance of pre and post inpatient and outpatient accounts from Epic Work Queues as assigned.
* Performs insurance benefits verification to confirm eligibility for scheduled or prospective services.
* Reviews for appropriate coordination of benefit and identifies discrepancies prior to clearance.
* Determines insurance authorization requirements for services scheduled or received.
* Ensures all scheduled services are authorized and appropriate notification and/or referral is obtained prior to the date of service to ensure payment for services.
* Ensures clear and timely documentation of all insurance clearance activities and outcomes, including authorization information in Epic. Performs all required follow-up to secure authorization pre-service, including follow-up with providers’ offices, scheduling departments and insurance companies.
* Performs medical necessity review for applicable services to ensure diagnosis is covered under insurance carrier clinical bulletin policy for outpatient appointments as scheduled.
* Determines patients’ benefit level based on in-network or out-of-network benefits.
* Identifies non-par plan status and follows appropriate out of network workflow based on service and payor type. Calculates and communicates patients’ estimated out of pocket hospital financial responsibility pre-service for scheduled or prospective services utilizing the Epic Estimator tool or International Calculator.
* Understands performance measures and is accountable for meeting monthly target goals as determined based on service and payer.
* Exercises skill in prioritizing assignments in order to complete work in a timely manner when there are changes in workload, assignments, and pressures of deadlines, competitive requirements and/or a heavy workload.
* Demonstrates optimal customer service skills when interfacing with patients, patients’ families, physicians, physician office staff, and hospital colleagues.
* Demonstrates excellent communication skills; uses appropriate vocabulary and grammar when obtaining and conveying information to physicians, nurses and staff at various levels; in person, over the phone, in writing and in electronically sent messages.
* Works collaboratively with and acts as a liaison with a variety of internal departments within NYULH, external business partners, external departments, and NYULH’s contracted payers.
* Works independently, takes initiative, and escalates to leadership appropriately.
* Responsible for answering and redirecting phone calls as needed and responding to emails timely.
* Adhere to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required trainings, and other Hospital mandated activities.
* Perform other duties as assigned.
Minimum Qualifications:
To qualify you must have a High School Diploma and 1-year experience in patient accounts or related field or an equivalent combination of education and experience.
Strong knowledge of front-end hospital, medical office, patient access, revenue cycle and /or practice operations. Knowledge of medical and insurance terminology. Knowledge of insurance benefit verification tools including payor portals, RTE, etc. Ability to perform with accuracy and attention to detail for meeting payer-imposed deadlines on a daily basis. Ability to compose and edit logical, detailed, comprehensive and grammatically correct correspondence. Ability to communicate effectively with a wide variety of personnel including patients, families, physicians and staff. Experience and competency with varied computer hardware and software, including registration and billing systems, word processing, spreadsheet, database, scheduling, communications. Ability to handle matters of highly confidential and sensitive nature. Ability to recognize and identify problems, recognize implications and propose alternative solutions. Skill in prioritizing assignments to complete work in a timely manner. Skill in working independently and in following through on assignments with minimal direction.
Preferred Qualifications:
Associates degree plus 2-3 years of experience in hospital admissions, patient accounts or medical records or in related field. Epic experience.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online.
If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal "EEO is the law" poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information.
NYU Langone Health provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $39,601.11 - $52,373.10 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
To view the Pay Transparency Notice, please click here
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