UR Financial Clearance Specialist - Days

Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary:

Responsibilities:

Essential Job Functions

Complete notification of patient admission following payer specific guidelines.

• Use websites for notification when available.
• Collect contact information for clinical review in electronic health record.
• Provides diagnosis and demographic information as requested by payers.
• Complete telephonic notification and online notification for failed UHC 278 transfers.

Ensure all payer sources (commercial and governmental) are verified as eligible.

• Complete verification process for all patient insurance if not complete.
• Investigate and correct all application alerts.
• Ensure payment order for payers is correct.
• Confirm payer order is correct.

Prioritize notifications.

• Use daily census to ensure all cases requiring notification are completed within 24 hours of admission.
• Prioritizes notification of payers, using available contact methods.
• Monitor reports to identify patients with change of status requiring notification.

Utilize online systems to complete notification and precertification.

Communication.

• Document complete and accurate information in Case Management software using established abbreviations.
• Communicate directly with UR nurse unique or unusual notification requirements.

Update insurance reference guide regularly based on changes in payer requirements.

Deliver required notification documents to patients in a timely manner based on payer requirements.

Adhere to safety and Infection Control guidelines.

• Reports unsafe conditions or accidents immediately.
• Maintain a safe working environment.
• Follow established guidelines for contact with patients in isolation.

Schedule:

Mon-Fri 7:30a-4p w/rotating scheduled weekends

Job Description:

Job Requirements

Education

• Associates degree in a health care related field required.
• Healthcare/ insurance experience may be considered in lieu of educational requirement.

Experience

• Minimum six months of insurance notification and/or authorization experience preferred.
• Experience with online payer notification programs preferred.

License/Certifications

• N/A

Skills/Knowledge/Abilities

• Skill with written and verbal communication.
• Skill working effectively with other employees, patients and external parties.
• Skill using Microsoft Office Suite and other specialized programs.
• Knowledge of medical terminology.
• Ability to organize, perform and track multiple tasks accurately.
• Ability to complete work accurately and within established timeframes.
• Ability to work independently and in a team.
• Ability to adapt to changing priorities.

Physical Requirements

Weight Demands

• Light Work - Exerting up to 20 pounds of force.

Physical Activity

• Not necessary for the position (0%):
  • Climbing
  • Crawling
  • Kneeling
• Occasionally Performed (1%-33%):
  • Balancing
  • Carrying
  • Crouching
  • Distinguish colors
  • Lifting
  • Pulling/Pushing
  • Standing
  • Stooping/bending
  • Twisting
  • Walking
• Frequently Performed (34%-66%):
  • Grasping
  • Reaching
  • Repetitive Motions
• Constantly Performed (67%-100%):
  • Fingering/Touching
  • Hearing
  • Keyboarding/typing
  • Seeing/Visual
  • Sitting
  • Speaking/talking

Job Hazards

• Not Related:
  • Chemical agents (Toxic, Corrosive, Flammable, Latex)
  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
  • Equipment/Machinery/Tools
  • Explosives (pressurized gas)
  • Electrical Shock/Static
  • Radiation Alpha, Beta and Gamma (particles such as X-ray, CAT scan, Gamma Knife, etc.)
  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
  • Mechanical moving parts/vibrations
• Rare (1-33%): - Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)

About Methodist:

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.