Financial Clearance Specialist 2

The Financial Clearance Specialist II serves as an experienced patient liaison for pre-service financial clearance Dana-Farber Cancer Institute (DFCI) and engagement throughout the patient’s financial experience at DFCI.

Reporting to, and with moderate direction from, the Access & Financial Engagement Supervisor, the Financial Clearance Specialist II is responsible for independently managing all work related to financial clearance of new or prospective patients at DFCI and ongoing authorization for patients with out-of-network / high risk insurance plans. Working in a fast-paced, high-volume, dynamic environment, the Financial Clearance Specialist II will demonstrate a strong understanding of payer coverage policies while applying appropriate payer guidelines to all aspects of out-of-network financial clearance. With moderate guidance, the Financial Clearance Specialist II will create accurate authorization requests and thorough and concise documentation, monitor requests for decision and communicate to the appropriate stakeholders, including the patient.

This role requires attention to detail, the ability to multitask and think strategically, as well as a commitment to service excellence with the goal of protecting the financial interests of both patients and the Institute.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
 

PRIMARY DUTIES AND RESPONSIBILITIES:

With moderate supervision, the Financial Clearance Specialist II:

• Reviews and monitors new patient daily appointment record and identifies and prioritizes patients with insurance plans that require prior authorization.
• Verifies insurance benefits, utilizing automated eligibility systems, payer portals, and/or telephone communication.
• Accurately and courteously communicates financial clearance process to patients, including a high-level benefits explanation, network status of DFCI for their plan, and authorization/ referral requirements; assists patients with resolving insurance related issues prior to initiating treatment.
• Reprioritizes work to respond to requests for clearance for clinically urgent patients and produces high quality work under time constraints.
• Monitors established patient work queues to ensure required authorization and/or referrals are obtained prior to service being rendered and within payer guidelines.
• Works with patient and/or Primary Care Physicians to complete payer-specific prior authorization request forms and applies appropriate guidelines to prior authorization requests.
• Responds to health plan-reviewed prior authorization requests that do not meet initial policy criteria. Works with the health plan to resolve issues and/or coordinate appropriate provider-to-health plan interventions (e.g., peer-to-peer discussions, letters of medical necessity, provider-initiated appeals, etc.).
• Effectively communicates with appropriate DFCI staff (e.g., New Patient Representatives, New Patient Coordinators, Established Patient Schedulers, clinical team) regarding financial clearance status.
• Maintains accurate, thorough, and complete records related to financial clearance activities to support post-claim denial workflows.
• Responsible for clinical trial financial clearance including monitoring reports for consented clinical trial patients to ensure standard of care authorizations are in place
• Provides escalation support for more complex situations and cases, including providing backup/coverage for the off-label (exception order) workflow.
• Assists in the training and mentoring of staff
• Assists in developing and maintaining training materials and other resources.
• Provides feedback for quality or process improvement initiatives and projects, as required.
• Performs other duties as directed.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

• Strong knowledge of managed care policies and medical terminology.
• Strong knowledge of Epic or other hospital information systems.
• Strong customer service and communication, both written and verbal.
• Strong relationship building skills and collaboration
• Strong analytical and problem-solving skills.
• Proficient use of Microsoft office.
• Ability to work independently.
• Ability to be a strong team player with demonstrated leadership capabilities.
• Ability to prioritize work and meet pre-determined deadlines with moderate supervision.
• Ability to work with sensitive patient information and maintain confidentiality.
• Ability to use good judgment, tact, and sensitivity.

MINIMUM JOB QUALIFICATIONS:

Minimum Education:

High school diploma or GED required; bachelor’s degree preferred.

Minimum Experience:

3 years of experience in a financial counseling, financial clearance or other role managing referrals or prior authorizations required.

Certification/Licensure/Registration:

None

At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.

Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law.  

EEO Poster

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Pay Transparency Statement

The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.

For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA).

$55,300.00 - $62,300.00