Senior Financial Clearance Coordinator – PFS-PASC-Authorization (1.0 FTE, Days)

Patient Services

1.0 FTE, 8 Hour Day Shift

At Stanford Children’s Health, we know world-renowned care begins with world-class caring. Thats why we combine advanced technologies and breakthrough discoveries with family-centered care. Its why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Childrens Hospital Stanford. And its why we need caring, committed people on our team – like you. Join us on our mission to heal humanity, one child and family at a time.

Job Summary

This paragraph summarizes the general nature, level and purpose of the job.

The Senior Financial Clearance Coordinator serves as the on-site subject matter expert for insurance-related matters and works closely with the Hospitals Financial Counselors and Financial Advocates to ensure the Health System is fully reimbursed from all available financial resources. They use appropriate tools to help verify eligibility and benefits, determine coverage limits, and provide auto-generated cost estimates within a designated time frame before scheduled appointments. This role acts as the main contact for resolving account issues, addressing patient concerns, and answering insurance billing questions, escalating matters to relevant Revenue Cycle departments (Financial Counselors, Billing, Authorizations) when necessary.

Essential Functions

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.

Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.

Must perform all duties and responsibilities in accordance with the hospital’s policies and procedures, including its Service Standards and its Code of Conduct.

Assigns financial clearance on all patients prior to treatment to teams of coordinators, which includes outlining and explaining financial obligations, billing process, relaying auto-generated patient estimates, collecting payment with the patients as necessary for the planned treatment and/or procedures.

Facilitates financial clearance process and discussions in the EMR and forwards necessary documentation to the revenue cycle and clinical department.

Maintains statistical information and reports as directed, can perform process improvement initiatives, peer-to-peer coaching for staff, lead team huddles, provide feedback and expectation settings on the floor.

In collaboration with Financial Clearance Management can monitor daily workque volume management

In collaboration with Financial Clearance Management can assist in managing scheduling and coverage issues

Assists patients in connecting with financial assistance departments – makes referrals to appropriate resource departments for program enrollment, and/or assists patients to fill out forms as necessary.

Serves as a liaison between Revenue Cycle and clinical operations to resolve claim denials and support re-submission.

Identifies emerging trends in payer reimbursement requirements and identifies, communicates, and collaborates to solve issues with revenue gaps/risks.

Ensures that practice coordinates the pre-registration process to include demographic and insurance verification and maintains accurate documents and recording of patient information within the EHR. Utilizing standardized documentation requirements and smart phrases.

Serves as point of contact and leads the coordinators in addressing account issues, patient concerns, or billing and insurance questions before they are escalated to a supervisor or manager.

Effectively determines primary, secondary, and tertiary liability by coordination of payer plan benefits.

Delegates which financial counselor will connect with patients when further explanation or education is needed regarding payment plans and complete financial assistance, including, but not limited to, all necessary forms, resources, payments, and submissions.

Communicates liabilities directly to patients and provides education on key insurance terms and rules; may often handle patients with more complicated insurance plans (e.g., Medicaid, self-pay, and inactive plans)

Demonstrates expert understanding of payer regulations and contracts and insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients¿ out-of-pocket liabilities.

Complies with HIPAA regulations, maintaining confidentiality and utilizing information only as necessary to complete work, as well as adheres to all other federal, state, and organizational requirements.

Ensures all coordinators are cross trained and responsible for assigned tasks following standardized practice, with the potential for service line rescheduling workflows in coordination with clinical scheduling requirements and protocols.

Supports in training new hires in collaboration with the supervisor and Management team.

Charged with maintaining the electronic Epic work queues for Financial Clearance, and in collaboration with Financial Clearance Management, manages the department daily volumes while meeting productivity requirements.

Responsible for identifying, escalating, processing improving gaps in workflow processes in collaboration with Financial Clearance management.

Identifying proper financial clearance departments for issues and communicating to clinical teams for escalations, and collaborations for improvements.

Manages communication via In-basket messages, emails, and other methods for completeness and accuracy of information needed to fulfill financial clearance requirements including providing feedback to ordering providers, as needed.

Reviews and updates member registration including processing real time payor eligibility.

Maintains a resource library of payor, benefit specific information and provider contact information.

Designates coordinator coverage of all internal and external customers by offering guidance and support for registration and insurance-related questions, process, and problems.

Communicates and provides feedback regarding changes, trends, and process to Supervisor and Manager.

Minimum Qualifications

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Education: High school diploma or GED equivalent

Experience: Five (5) years of progressively responsible and directly related work experience.

Licensure/Certification: None required.

Knowledge, Skills, & Abilities

These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.

Ability to analyze operational and procedural problems and develop, recommend and evaluate proposed solutions.

Ability to speak and write effectively at a level appropriate for the job.

Ability to work well with individuals at all levels of the organization.

Knowledge of computer systems and software used in functional area.

Knowledge of Medical Terminology.

Knowledge of Medicare, Medi-Cal, Workers Comp, Managed Care (HMO, PPO, POS, etc ), Childrens Health Programs (CCS, GHPP, Healthy Families, etc ).

Ability to work effectively and independently with minimal supervision of daily work, while maintaining a collaborative and communicative environment with leadership, teammates, clinical teams, and revenue cycle departments.

Physical Requirements and Working Conditions

The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.

Pay Range

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data.

Typically, new team members join at the minimum to mid salary range.

Minimum to Midpoint Range (1.0 FTE): $ to $

Equal Opportunity Employer

L ucile Packard Children’s Hospital Stanford strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, LPCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements, and where applicable, in compliance with the San Francisco Fair Chance Ordinance. REQNUMBER: 20141-1A