Financial Clearance
Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.
Day (United States of America) Location 680 Lake Shore Drive Job Description General Summary: The Financial Clearance I secures required precertification/prior authorizations for ambulatory, inpatient, outpatient surgery, and admissions cases. Interprets and obtains data for medical necessity and precertification compliance; calculates, explains, and collects patient liabilities; and completes third-party eligibility and benefit verification in order to ensure compliance with government/regulatory and third-party payer requirements, and to ensure prompt and accurate billing and payment of hospital accounts receivable. Essential Job Functions- Ensures pre-certifications are completed prior to visit for all scheduled appointments.
- Manages precertification cases for outpatient surgery, admission authorizations, radiology, sleep studies, and referrals for office visits.
- Maintains current knowledge of insurance requirements, benefit provisions and pre-certification.
- Contacts patient and/or division teams to provide updates on precertification status and timeliness.
- Generates patient estimates and contacts patient to provide details on patient financial responsibility.
- Updates patient’s registration information as needed.
- Consistently meets quality and productivity requirements.
- Other job functions as assigned.
- High school graduate required; BS or BA preferred.
- Excellent communication/listening skills.
- Demonstrates knowledge of utilization management process including communication with payors and benefit authorization for applicable situations.
- Experience reviewing medical charts/records and abstracting relevant clinical data to support medical necessity of scheduled procedures.
- Minimum two years’ experience in pre-certification initiation in a hospital/facility setting or physician office environment working precertification for inpatient, outpatient, outpatient surgery and admissions.
- Knowledge of medical terminology, third party billing, utilization management and managed care requirements.
- Proficient computer skills and aptitude.
- Substantial interpersonal skills sufficient to work effectively with pediatric patients, families, physicians, nursing and other allied health and medical center personnel.
- Problem solving ability and able to handle multiple priorities.
- Supplemental Life, AD&D and Disability
- Critical Illness, Accident and Hospital Indemnity coverage
- Tuition assistance
- Student loan servicing and support
- Adoption benefits
- Backup Childcare and Eldercare
- Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
- Discount on services at Lurie Children’s facilities
- Discount purchasing program
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