Financial Clearance Specialist

3 weeks ago

Baltimore MD, United States University of Maryland Medical System Full time

At University of Maryland Charles Regional Medical Center (UM CRMC), our talented and diverse groups of professionals represent our strength. Through teamwork and a collaborative work environment, we proudly serve our patients and our community with unwavering commitment. Under general supervision, responsible for processing the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including, validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. Responsible for triaging routine financial clearance work.
Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals.
Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles.
Works directly with physicians office staff to obtain clinical data needed to acquire authorization from carrier.
Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status.
Assists management with denial issues by providing supporting data.
Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services.
Must be willing to travel between facilities as needed (applies to specific UMMS Facilities).
High School Diploma or equivalent is required.
Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.
Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred.
Knowledge of medical and insurance terminology.
Knowledge of medical insurance plans, especially manage care plans.
Ability to understand, interpret, evaluate, and resolve basic customer service issues.
Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.
Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues.
Some knowledge of medical terminology and CPT/ICD-10 coding.
Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred.
Knowledge of the Patient Access and hospital billing operations of Epic preferred.
All your information will be kept confidential according to EEO guidelines.
We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at careers@umms.edu.

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