Financial Clearance Specialist
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Job Description
Financial Clearance Specialist processing patient financial clearance aspects and insurance verification in healthcare. Liaising between patients and insurance payors for scheduling and authorizations.
Responsibilities:
- Process and verify administrative and financial components of financial clearance including validation of insurance benefits, medical necessity, routine and complex pre-certification, prior-authorization, scheduling and pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share.
- Obtain pre-certifications, authorizations, and referrals for upcoming appointments.
- Communicate recommended changes to schedules and care planning to ensure alignment with authorization requests and payor compliance
- Liaison between patient, insurance payors and providers to obtain prior authorization for prescheduled services
- Effectively address issues and offer information and support to both patients and physicians concerning financial clearance matters
- Process stat request prioritization
- Verify demographic information
- Apply payor changes to registration
- Verify, edit and/or remove user defined referral counts editing final status of referrals
- Edit the scheduled date within the referral, pend referrals to any pools, suppressing expiring referrals messages, accessing assigned referral work queues, defer/activate referral work queue items, use referral templates
- Apply critical thinking skills to identify and resolve problems proactively
Requirements:
- High School Diploma or equivalent
- 3+ years’ experience with patient registration in a hospital or physician office, directly with obtaining patient demographic and financial information, handling insurance verification and obtaining authorizations
- Proficient with commercial and government insurance plans, payer networks, government resources
- Proficient with medical and insurance terminology
- Strong customer service skills, including ability to understand, interpret, evaluate, and resolve basic to complex service issues.
- Strong attention to detail and accuracy
- Excellent verbal and written communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, management, patients, client, and external agencies
- Ability to work with a variety of stakeholders
- Proficient in utilizing a variety of computer applications and software, including but not limited to Microsoft Office Suite, Internet Explorer, and other relevant programs
- Proven track record in roles that involve managing multiple critical priorities, with a focus on delivering high-quality results and meeting performance metrics.
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