Description
The Financial Clearance Specialist 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. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Individuals 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. Specialists must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Financial Clearance Specialists must determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. The individual will be expected to communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Specialists must also determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Representatives are to conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative. Specialists must maintain compliance with HIPAA regulations as it pertains to the insurance processes. Representatives must 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. Financial Clearance Specialist I is responsible for submitting authorizations for an ambulatory visit. Must be able to verify insurance and basic knowledge of both CPT codes and medical terminology. Must also be able to understand and interpret patient liability and benefits
Essential Duties:
- Responsible for obtaining insurance information/verification/authorization to ensure financial clearance of patient accounts. Updates both professional and / or hospital registration systems.
- Responsible for completing all registration and insurance fields in both professional and / or hospital registration information systems
- Responsible for calling insurance or use Internet portals to obtain and document: a) Insurance eligibility and benefits, b) Financial responsibility, c) Authorization and / or Pre-Certification as required.
- Responsible for calculating patient liability on hospital and professional accounts and communicating/collecting the liability from the patient.
- Ensure all insurance plans are properly selected in all registration and scheduling information systems
- Responsible for clearing assigned worklists in any of the information systems.
- Communicate with physician offices regarding proposed admissions, special procedures, outpatient referrals and same day surgeries.
- Responsible for preparing pre-registration on scheduled procedures (i.e. Ancillary, Diagnostic, Surgeries).
- Contact patients and / or Physician office as needed for additional information.
- Utilize fax applications as appropriate and perform document imaging as required.
- Actively obtain written clinical documentation for authorization submissions from Medical/Nursing staff.
- Submit pre-certification documentation to third party payers for authorization with correct CPT and ICD coding.
- Research payer medical policy requirements for treatment authorizations and understand process for submitting pre-certification requests.
- Follow up on outstanding authorization requests and medical documentation requests in a timely manner.
- Communication with medical/clinical staff and patients on authorization status/outcome and / or with Director on denied or disputed claims.
- Scan all authorizations into appropriate system under the respective patient accounts and document authorization outcomes in the registration system.
- Perform all other duties as assigned.
Required Qualifications:
- Req High school or equivalent Or GED required.
- Req 1 year Experience in a hospital environment with authorization and insurance verification responsibilities.
- Req Knowledge of business office procedures.
- Req Knowledge of medical terminology and coding.
- Req Knowledge of grammar, spelling, and punctuation to type patient information.
- Req Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.
- Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills. Capable of working assigned shifts, overtime when approved.
- Req Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.
Preferred Qualifications:
Required Licenses/Certifications:
- Req 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)
The hourly rate range for this position is $19.00 - $29.77. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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