Financial Clearance Specialist
Core
Ensures financial clearance for patient admissions, surgeries, and outpatient procedures by verifying insurance eligibility, benefits, and medical necessity to maximize timely reimbursement.
Role type
Healthcare revenue cycle financial clearance specialist
Builds
Financial clearance for hospital admissions, surgeries, and diagnostic exams
Domain
Healthcare / Revenue Cycle Management
Required skills
Insurance eligibility verification, Medicare/Medicaid rules knowledge, CPT/ICD-10 coding, pre-authorization facilitation, patient demographic data collection, medical necessity checks, Epic system navigation, out-of-pocket estimation, denial resolution
Preferred skills
Healthcare finance experience, healthcare insurance experience, Bachelor's degree, additional language skills
Technologies
Epic, NDAS, ASF
Responsibilities
Verify insurance eligibility and benefit levels; Facilitate pre-authorization of diagnostic exams; Ensure all admissions and scheduled surgeries are financially cleared; Perform medical necessity checks for scheduled services; Contact patients regarding high out-of-pocket liabilities; Work on denied accounts to gather required information; Monitor admission and scheduled surgery flow through the revenue cycle.
Seniority
Mid-level, hands-on IC