Financial Clearance Specialist, PRN

2 weeks ago

Towson Maryland, United States University of Maryland Medical System Full time
Job Description

General Summary:

 

Under limited supervision, responsible for coordinating 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 complex financial clearance work.

 

Principal Responsibilities and Tasks

 

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

 

Coordinates 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.

 

Manages service line, and/or complex multi-payer insurance verification and benefit eligibility validation and prior authorizations, including obtaining and completing documentation for pre-certification and referrals/authorizations.

 

Performs root cause analysis on no authorization denials.

 

Cross trains and provides guidance to team of financial clearance specialists in day to day operations

 

Maintains regular communication and follow-up with patients and families to keep them informed of clearance and self-pay matters.

 

Maintains regular communication and follow-up with program and department contacts regarding pending insurance, coverage, and other payment-related matters.

 

Develops denial mitigation strategies with staff in registration, patient financial services, and clinical areas, as applicable.

 

Must be willing to travel between facilities as needed (applies to specific UMMS Facilities).

 

Performs other duties as assigned.

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