Financial Clearance Coordinator

Here, it's different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.

Here, the nation's brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist's outlook, a trailblazing spirit, and a celebrated history, we're making new strides every day.

We've been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report.

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties.

Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat.

That's why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through our doors.

A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it's different.

The Financial Clearance Coordinator manages assigned high-risk insurance accounts within the Finance department. Verifies insurance benefits, obtains authorizations and pre-certifications, performs notice of admissions, and updates cost estimates prior to outpatient visits or scheduled admissions. Serves as a liaison between the family, provider, and insurance company to ensure financial clearance of assigned accounts.

Department Name: Insurance Verification
Job Status: Full time, 40 hours per week.
Shift: Day shift, Hybrid

• EDUCATION - High School Diploma or Equivalent
• EXPERIENCE - One (1) year of customer service experience
  

Population Specific Care:
*No direct patient care.
ESSENTIAL FUNCTIONS
An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all the functions the employee may be expected to perform.

1.Ensures accounts are secured and complete by performing benefit verification, estimate finalization, notice of admission, and/or prior authorization for services. Notifies insurance companies of expected services rendered and secures authorization/pre-certification as per payer requirements.
2.Ensures patients are informed of benefits and associated costs by creating and communicating personalized estimates of financial responsibility.
3.Verifies that all required referrals are in place for services to be covered by the payor and verifies policy details including any exclusions the payor may have for expected services rendered.
4.Addresses referral/authorization issues by coordinating with families, clinics, and referring providers to ensure financial security of encounters.
5.Verifies, updates, and edits insurance coverage information for patients.
6.Identifies and resolves issues related to insurance information, referrals, and authorizations promptly.
7.Utilizes payer portals, automation, and relevant systems to secure financial aspects of accounts.
8.Participates in peer development programs and serve as a resource for co-workers and staff.
9.Adheres to HIPAA regulations and appropriately document all contacts within PHI-secured systems.
10.Provides customer service in person, by phone, or email; assists patients, families, providers, and staff with insurance or cost estimate-related inquiries and escalations, and self-pay estimates for those without coverage or for non-covered services. Responds to inquiries about anticipated costs, calculate balances based on coverage and benefits, coordinate with clinics and families.
11.Assists in payment collection before services are rendered by utilizing the cost estimate tool to ensure financial security of the organization.
12.Navigates hospital account records to identify billed services and identifies how insurance coverage was applied. Resolves errors within accounts regarding eligibility, verification, and authorization to ensure clean claims.
13.Collaborates with various departments throughout the organization to ensure accounts are secured prior to date-of-service.
14.Adheres to departmental guidelines for various expectations including productivity, quality, and prioritization of workload.

SCOPE AND LEVEL
Guidelines: Guidelines are generally numerous, well established, and directly applicable to the work assignment. Work assignment and desired results are explained by general oral or written instructions.
Complexity: Duties assigned are generally repetitive and restricted in scope but may be of substantial intricacy. Employees primarily apply standardized practices.
Decision Making: Decisions or recommendations on non-standardized situations are limited to relating organizational policies to specific cases. Brings non routine issues to supervisor. Problems not covered by guidelines or without precedent are taken up with the supervisor.
Communications: Contacts with the public or employees where explanatory or interpretive information is exchanged, gathered, or presented - discretion and judgment are required within the job function's parameters.
Supervision Received: Under normal supervision, within a standardized work situation, the employee performs duties common to the line of work without close supervision or detailed instruction. Work product is subject to continual review.

Ability to Perform Essential Functions of the Job

PHYSICAL REQUIRMENTS
Audio-Visual: Hearing: Good
Audio-Visual: Near Vision: Good
General Activity: Sit: 2-4 hrs. per day
Motion: Bend: Up to 1/3 of time
Use of Hands/Feet: Precise Motor Function
Weight Lifted/Force Exerted: Up to 30 pounds

WORK ENVIRONMENT
Mental and Emotional Requirements: Independent discretion/decision making.
Mental and Emotional Requirements: Makes decisions under pressure.
Mental and Emotional Requirements: Manages stress appropriately.
Mental and Emotional Requirements: Works with others effectively.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.

Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.