Financial Clearance Specialist IV - Admitting - Full Time 8 Hour Variable Shift (Non Union)
Core
Verify insurance eligibility, benefit verification, and authorization processes to optimize reimbursement and adjudicate Letters of Agreement for non-contracted payers in a hospital setting.
Role type
Senior billing and insurance clearance specialist
Builds
Accurate claim management and legal documentation for professional and hospital services
Domain
Healthcare administration / Insurance adjudication
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Insurance plan interpretation, Division of Financial Responsibility (DOFR) analysis, Patient liability collection, Medicare Secondary Questionnaire completion, HIPAA compliance, Medical terminology, CPT code interpretation, Contract requirement knowledge, Payer type proficiency (HMO, PPO, POS, EPO, Capitation, Military, Workers' Comp)
Preferred skills
Benefit negotiation, Authorization submission for all service scopes
Technologies
None stated
Responsibilities
Secure mutually signed Letters of Agreement for non-contracted payers; Determine and collect patient liability prior to service; Complete Medicare Secondary Questionnaires; Maintain compliance with HIPAA regulations; Interpret contract vs non-contract payer language; Submit authorizations for all service types.
Seniority
Mid-level, hands-on specialist