Financial Clearance Specialist

4 days ago


Glen Burnie, Maryland, United States University of Maryland Medical System Full time
Job Summary

We are seeking a highly skilled Financial Clearance Specialist to join our team at the University of Maryland Medical System. As a key member of our patient access team, you will be responsible for ensuring seamless financial clearance processes for patients, insurance companies, and healthcare providers.

Key Responsibilities
  1. Financial Clearance: Process administrative and financial components of financial clearance, including validation of insurance and 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.
  2. Insurance Verification: Initiate and track referrals, insurance verification, and authorizations for all encounters.
  3. Communication: Utilize third-party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements, and benefit information, including copays and deductibles.
  4. Clinical Data: Work directly with physician's office staff to obtain clinical data needed to acquire authorization from carriers.
  5. Authorization: Input information online or call carriers to submit requests for authorization; provide clinical backup for tests and document approval or pending status.
  6. Process Improvement: Identify issues and problems with referral/insurance verification processes; analyze current processes and recommend solutions and improvements.
  7. Pending Authorizations: Review and follow up on pending authorization requests.
  8. Service Coordination: Coordinate and schedule services with providers and clinics.
  9. Discrepancies: Research delays in service and discrepancies of orders.
  10. Denial Issues: Assist management with denial issues by providing supporting data.
  11. Patient Registration: Pre-register patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing.
  12. Interdepartmental Collaboration: Develop and maintain a working rapport with interdepartmental personnel, including ancillary departments, physician offices, and financial services.
  13. Medicare Patients: Assist Medicare patients with the Lifetime Reserve process where applicable.
  14. Payer Notification: Review previous day admissions to ensure payer notification upon observation or admission.
  15. Travel: Must be willing to travel between facilities as needed.
Requirements
  1. Education: High School Diploma or equivalent is required.
  2. Experience: Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access, or related experience.
  3. Preferred Experience: Experience in healthcare registration, scheduling, insurance referral, and authorization processes.
Knowledge, Skills, and Abilities
  1. Medical and Insurance Terminology: Knowledge of medical and insurance terminology.
  2. Medical Insurance Plans: Knowledge of medical insurance plans, especially managed care plans.
  3. Customer Service: Ability to understand, interpret, evaluate, and resolve basic customer service issues.
  4. Verbal Communication: Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.
  5. Analytical Skills: Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues.
  6. UB04 and EOB: Basic working knowledge of UB04 and Explanation of Benefits (EOB).
  7. Medical Terminology: Some knowledge of medical terminology and CPT/ICD-10 coding.
  8. Dependability: Demonstrate dependability, critical thinking, and creativity and problem-solving abilities.
  9. Registration and Admitting Services: Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes.
  10. Patient Access and Hospital Billing Operations: Knowledge of the Patient Access and hospital billing operations of Epic.


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