Title: Insurance & Financial Clearance Coordinator

Location: Upper East Side; Lower East Side

Org Unit: WCINYP Pre-Authorization

Work Days:

Exemption Status: Non-Exempt

Salary Range: $27.47 - $32.64

*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices

Position Summary

Under direct supervision, is responsible for coordinating and verifying insurance eligibility, benefits, and prior authorization for Outpatient Radiology procedures. Responsible for notifying patients and helping arrange alternative payment options when insurance does not cover services.

Job Responsibilities

• Responsible for entering or confirming that patient data (demographics, guarantor, and insurance information) inputted in EPIC is accurate, complete, and up to date.

• Utilize dedicated insurance carrier portals, when available, to conduct verification of eligibility and Radiology specific benefits. Confirm and document the patients’ health insurance benefits and authorization requirements.

• Review and determine authorization requirements for scheduled services and utilize payer-specific portals to submit prior authorization requests before the service date.

• Ensure that the appropriate procedure code(s), diagnosis code(s), and clinical information are utilized and submitted during the prior authorization process.

• Alert patients before their appointment of inactive policies, difficulties obtaining a quote of benefits or authorizations, and provides them with financial counseling based on the established criteria.

• Communicate with clinical staff, administrators, and patients, regarding insurance-related problems or discrepancies. Contact patients to request updated insurance information. Provide patients with guidance on how to resolve insurance-related issues.

• Provide patients with estimated charges when requested. Generate and provide a Good Faith Estimate (GFE) of charges for services provided to an uninsured patient or insured patient who elects not to submit a claim to their health insurance for coverage.

• Manages inbound and outbound phone calls and inquiries. Utilize problem-solving skills to determine the best course of action to resolve any problems resulting from insurance coverage or prior authorizations.

• Perform related duties as assigned.

Education

• High School Diploma

Experience

• Approximately 2 years prior related experience within the medical field.

Knowledge, Skills and Abilities

• Knowledge of CPT, ICD9, and ICD10 coding.

• Excellent communication skills (both verbal and written).

• Professional appearance, punctuality, and a sense of urgency.

• Ability to plan and prioritize work while responding to rapidly changing priorities.

• Detail oriented.

Licenses and Certifications

Working Conditions/Physical Demands

• Standard office work.

• Role may require the ability to work flexible hours, which may include early mornings and/or late nights.

Weill Cornell Medicine is a comprehensive academic medical center that is committed to excellence in patient care, scientific discovery, and the education of future physicians and scientists in New York City and around the world. Our doctors and scientists - faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization - are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U.S. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian/Lower Manhattan Hospital, NewYork-Presbyterian Hospital/Brooklyn Methodist Hospital, NewYork-Presbyterian Hospital/Westchester Behavioral Health Center, and NewYork-Presbyterian/Queens. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients - the center of everything we do. Weill Cornell Medicine is an Equal Employment Opportunity Employer. Weill Cornell Medicine provides equal employment opportunities to all qualified applicants without regard to race, sex, sexual orientation, gender identity, national origin, color, age, religion, protected veteran or disability status, or genetic information.