RN - Financial Clearance Specialist (Remote)

Principle Responsibilities

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  Ensure services/procedures are appropriate and necessary per health benefit plans.
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    Assess clinical data from medical records to obtain authorization for scheduled services.
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    Abstract and submit clinical data from medical records to insurance payers.
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    Utilize clinical screening criteria and reviews insurance payer medical policies to ensure patients meet medical necessity for scheduled services.
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    Assure the medical record has the proper physician clinical documentation.
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    Monitor for continued authorization, communicates results and opportunities to nurses, physicians, finance, case managers, and payers.
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  Facilitate denials and appeals process.
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    Evaluate potential denials or payment issues and initiates communication with physician or clinician regarding next steps.
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    Prepare and facilitates appeals for denied claims.
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    Facilitate peer to peer requests between the ordering physician, and the payer physician.
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    Other duties as assigned.

Job Requirements

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  Bachelor's degree in Nursing required
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  2 to 5 years experience in an acute hospital or medical clinic setting required
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  2 to 5 years health insurance authorization experience preferred and
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  2 to 5 years experience using InterQual, MCG, or other clinical criteria preferred
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  Licensed Registered Nurse - MN Board of Nursing required upon hire

Leadership Capabilities

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  See the Big Picture: Know where we are going as an organization. Use sound judgement and critical thinking to make good decisions that support our mission.
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    I know where Allina is going and how my role fits into this picture
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    I capture important lessons and share them to foster innovation
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    I am good at anticipating the implications of my decisions
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    I understand and apply the disciplines of continuous improvement
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  Inspire Greatness: Inspire others by connecting their purpose to the broader mission. Lead others through change and celebrate success.
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    I help my team connect to the broader mission
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    I see and fulfill my role in motivating the team around me
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    I celebrate success and help my partners see what is possible with change
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    I call out and address unexpected roadblocks or problems
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  Foster Learning and Growth: Role model growth, ongoing development and self-care. Empower, coach and encourage others to be at their best selves.
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    I role-model self-care and ongoing development
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    I share my knowledge and coach others to foster growth and success
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    I demonstrate enthusiasm for learning
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    I candidly advocate for the resources I need
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    I support my colleagues in their development and growth
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  Deliver Excellence: Set and align clear goals, measure results, and continually improve safety, quality, experience, and innovation.
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    I take ownership of outcomes and fulfillment of goals
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    I facilitate adjustments to assure positive results
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    I work with a sense of urgency, concern and determination
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    I use well-grounded approaches to create sustainable solutions repeatedly
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    I engage and foster improvements to impact safety, quality, and efficiency
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  Succeed Together:Connect with others authentically. Recognize the value of each individual and seek diverse points of view. Collaborate to succeed together.
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    I consider how decisions might impact my colleagues
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    I am generous in my commitment to supporting the needs of my partners
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    I respect others’ opinions, praise good work and encourage all team members to be involved
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    I seek common ground and work to create mutually beneficial outcomes

Functional Competencies

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  Analytical Thinking: Uses basic logic and common sense to arrive at solutions.
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  Business Impact: Role has impact on the department.
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  Collaboration: Develops partnerships with internal team members.
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  Communication Skills: Able to communicate well in straight-forward situations.
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  Problem Solving: Completes routine and repetitive tasks where tasks are straightforward.

Physical Demands

Sedentary:

Lifting weight Up to 10 lbs. occasionally, negligible weight frequently

Employee works from home. Hours are 730a-4p with flexibility on work demands.