Financial Clearance Specialist
Core
Facilitates pre-authorization of diagnostic exams and ensures financial clearance for admissions, surgeries, and outpatient procedures to maximize patient reimbursement.
Role type
Healthcare financial clearance specialist
Builds
Patient financial accounts and insurance authorizations for Northwestern Medicine
Domain
Healthcare / Medical Billing & Insurance
Deliverable
client delivery
Required skills
Medicare/Medicaid regulations, CPT/ICD-10 coding, insurance eligibility verification, pre-authorization processing, patient demographic data collection, Epic system navigation, medical necessity checks, out-of-pocket estimation
Preferred skills
Healthcare finance experience, healthcare insurance experience, Bachelor's degree
Technologies
Epic, NDAS, ASF
Responsibilities
Facilitates pre-authorization of diagnostic exams between physicians and insurance carriers; Ensures all admissions, scheduled surgeries, and outpatient procedures are financially cleared; Reviews patient electronic medical records for diagnosis and pre-treatment; Verifies eligibility and benefit information using online programs; Contacts patients regarding high out-of-pocket liabilities and financial policies; Works on denied accounts to gather required documentation for pre-certification.
Seniority
Mid-level, hands-on IC