Financial Clearance Specialist, Entry Level

About the position

This remote position involves processing patient, insurance, and financial clearance aspects for both scheduled and non-scheduled appointments. The role includes validating insurance and benefits, handling pre-certifications and prior authorizations, and managing scheduling and pre-registration tasks. The position requires effective communication with healthcare providers and patients to ensure smooth financial clearance processes.

Responsibilities
• Process administrative and financial components of financial clearance including validation of insurance/benefits and medical necessity validation.
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• Handle routine and complex pre-certification and prior authorization requests.
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• Schedule and pre-register patients, obtaining necessary demographic and insurance information.
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• Initiate and track referrals, insurance verification, and authorizations for all encounters.
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• Utilize third-party payer websites and real-time eligibility tools to retrieve coverage eligibility and benefit information.
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• Work directly with physician's office staff to obtain clinical data needed for authorization.
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• Input information online or call carriers to submit requests for authorization and document approval or pending status.
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• Identify issues with referral/insurance verification processes and recommend solutions.
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• Review and follow up on pending authorization requests.
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• Coordinate and schedule services with providers and clinics.
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• Research delays in service and discrepancies of orders.
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• Assist management with denial issues by providing supporting data.
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• Assist Medicare patients with the Lifetime Reserve process where applicable.
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• Review previous day admissions to ensure payer notification upon observation or admission.
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• Perform other duties as assigned.

Requirements
• High School Diploma or equivalent is required.
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• Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.
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• Knowledge of medical and insurance terminology.
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• Knowledge of medical insurance plans, especially managed care plans.
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• Ability to understand, interpret, evaluate, and resolve basic customer service issues.
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• Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills.
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• Intermediate analytical skills to resolve problems and provide information and assistance with financial clearance issues.
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• Basic working knowledge of UB04 and Explanation of Benefits (EOB).
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• Some knowledge of medical terminology and CPT/ICD-10 coding.

Nice-to-haves
• Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred.
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• Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred.
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• Knowledge of the Patient Access and hospital billing operations of Epic preferred.

Benefits
• Opportunity to grow professionally in a supportive and stimulating environment.
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• Consistently named among the top 100 Best Places to Work in Maryland.

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