Financial Clearance Specialist

2 days ago

Towson, 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 processing patient, insurance, and financial clearance aspects for both scheduled and non-scheduled appointments.

Key Responsibilities
  1. Process 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.
  2. Initiate and track referrals, insurance verification, and authorizations for all encounters.
  3. 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. Work directly with physician's office staff to obtain clinical data needed to acquire authorization from carrier.
  5. Input information online or call carrier to submit request for authorization; provide clinical back-up for test and document approval or pending status.
  6. Identify issues and problems with referral/insurance verification processes; analyze current processes and recommend solutions and improvements.
  7. Review and follow up on pending authorization requests.
  8. Coordinate and schedule services with providers and clinics.
  9. Research delays in service and discrepancies of orders.
  10. Assist management with denial issues by providing supporting data.
  11. Pre-register patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing.
  12. Develop and maintain a working rapport with inter-departmental personnel, including ancillary departments, physician offices, and financial services.
  13. Assist Medicare patients with the Lifetime Reserve process where applicable.
  14. Review previous day admissions to ensure payer notification upon observation or admission.
  15. Must be willing to travel between facilities as needed.
Requirements
  • High School Diploma or equivalent required.
  • Minimum two 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.
Preferred Qualifications
  • Knowledge of medical and insurance terminology.
  • Knowledge of medical insurance plans, especially managed 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.
  • Basic working knowledge of UB04 and Explanation of Benefits (EOB).
  • Some knowledge of medical terminology and CPT/ICD-10 coding.
  • Demonstrate dependability, critical thinking, and creativity and problem-solving abilities.
  • 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.

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