Moffitt Cancer Center is seeking a Financial Clearance Specialist II to secure the financial health of the center by verifying patient eligibility, obtaining authorizations, and finding financial alternatives. You will be responsible for ensuring patients can receive care without financial barriers and that the center is properly reimbursed for services. Your work at Moffitt is both a career and a mission, contributing to a nationally recognized organization dedicated to the prevention and cure of cancer.
What You'll Do
- Request authorizations for all services via website portals, fax, and phone calls.
- Navigate clinical records and understand medical oncology documentation.
- Apply basic knowledge of diagnosis and service coding for proper authorization submissions.
- Provide clinical information to health plans or physician’s offices via phone, online, or fax.
- Read and understand clinical orders from providers to submit authorizations for proper services.
- Navigate appointment center tool to advise on needs for approaching services.
- Call health insurances, primary physicians offices, and patients/families regarding authorizations and coverage.
- Communicate with other departments including Clinical Trial Coordinators, Patient Appointment Center, and the Business Office.
- Submit appeals and reconsiderations via phone or fax for better coverage attempts.
- Notify patients when coverage cannot be obtained.
- Manage assigned worklists to ensure services are covered well before appointment dates.
- Navigate worklists including data input, documentation, filtering, and working with RPA automation.
- Maintain a steady workflow to keep worklists current and prevent falling behind.
- Follow up on all worklist encounters by calling health plans, checking web submissions, and reviewing faxes.
- Balance multiple worklists using time management to prioritize timely patient approvals.
- Complete specific daily metrics of encounters to ensure timely patient care.
- Provide error-free work on assigned worklists to minimize revenue loss.
- Work all worklists throughout each day.
- Respond to correspondence from payers and/or patients.
- Ensure proper multi-tasking to manage worklist assignments between calls.
- Ensure correct collection, documentation, and appropriate actions are documented.
- Meet or exceed established productivity goals and notify your Supervisor of any issues preventing goals.
- Demonstrate proactiveness when not meeting Productivity Goals by seeking re-education and a game plan.
- Meet or exceed monthly QA score per department guidelines.
- Accept feedback from your supervisor each month.
- Follow procedures outlined in operational guidelines and score cards.
What We're Looking For
- Minimum of six (6) months of experience as a Financial Clearance Specialist I or II and meet all requirements of the Financial Clearance Unit Promotional Program for Level III.
- Healthcare Finance Management Association (HFMA) Certified Revenue Cycle Representative (CRCR) certification. You must obtain this within 12 months from your date of hire or transfer.
Technical Stack
- Trace
- pixcert
- Soarian
- XR (Cerner)
Moffitt Cancer Center is an equal opportunity employer.
