Financial Clearance Specialist III
FinancialClearanceSpecialistIII-PreArrival-FullTime8HourDays(Non-Exempt)(Non-Union)
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“Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union) at Financial Clearance Specialist III. Skills: insurance verification, authorization, patient liability, financial clearance. Ensure insurance eligibility, benefit verification, authorization processes. Document accurate insurance information and authorization details”
What You'll Achieve.
prevent denials or penalties; optimize reimbursement from both the payer and patient; ensure financial clearance of patient accounts
Industry & Context.
problem solving customer skills; research/analytical skills
What They're Looking For.
Must Have
High school or equivalent Or GED required, 2 years Admitting/ insurance verification experience in a hospital, health plan or Physician office environment, Broad experience in financial counseling and co-pay collections, Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non- invasive procedures is highly desirable, The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting, Ability to interrupt patient’s insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers, problem solving customer skills, Knowledge of business office procedures, Knowledge of medical terminology and coding, Knowledge of grammar, spelling, and punctuation to type patient information, Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology, Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types, Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public, Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills, Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees, Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
What You'll Do.
Ensure insurance eligibility
authorization processes
Document accurate insurance information and authorization details
Maintain working knowledge of insurance plans
Run eligibility and secure full benefit coverage information
Verify insurance coverage for inpatient and outpatient accounts
Determine if pre-certification
pre-authorization or referral is required
Communicate with providers and team regarding out-of-network issues
and collect patient liability prior to service
Complete Medicare Secondary Questionnaire accurately
Maintain compliance with HIPAA regulations
Maintain professional development
Submit authorizations for surgery
Obtain insurance information/verification/authorization
Update professional and/or hospital registration systems
Ensure all insurance plans are properly selected
Call insurance or use Internet portals
Understand and articulate patient’s liability
Perform mathematical calculations
Contact Physician office when services denied
Submit authorizations via the Valor software tool
Clear assigned worklists in information systems
Complete Documentation of all authorization information
Submit pre-certification documentation to third party payers
Research payer medical policy requirements
Follow up for routine requests
Scan all authorizations into appropriate system
Document authorization outcomes in registration system
Perform all other duties as assigned
How You'll Work.
Team & Collaboration
Communicate with providers and team regarding out-of-network issues; Communicate with physician offices regarding proposed admissions; Establish and maintain effective working relationships with patients, employees, and the public
Communication Scope
communication (written and verbal)
Full Job Description
The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. Communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative. Maintain compliance with HIPAA regulations as it pertains to the insurance processes. Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry. Responsible in submitting authorizations for surgery, GI , Imaging chemotherapy, Infusions, invasive and non-invasive procedures, transplants, and all other services as required. **Essential Duties:** * Responsible for obtaining insurance information/verifi
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