Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Rotating (Non-Exempt) (Non-Union)
Core
Ensuring insurance eligibility, benefit verification, and authorization processes to prevent denials and optimize reimbursement for patient accounts.
Role type
Senior financial clearance specialist (healthcare billing)
Builds
Patient financial clearance and insurance authorization workflows
Domain
Healthcare administration / Medical billing
Deliverable
client delivery
Required skills
Insurance eligibility verification, benefit calculation, pre-certification/authorization submission, patient liability assessment, CPT/ICD coding knowledge, medical terminology, HIPAA compliance, data entry
Preferred skills
Experience with surgery/GI/Imaging/Chemo/Infusion authorizations, financial counseling, mathematical calculations for out-of-pocket costs
Technologies
Valor software, hospital registration systems, payer portals
Responsibilities
Verify insurance eligibility and benefits for inpatient/outpatient accounts; Obtain pre-certifications and authorizations for procedures; Calculate patient liability including deductibles and co-insurance; Communicate with providers regarding denied claims or out-of-network issues; Document authorization outcomes and collect patient balances; Complete Medicare Secondary Questionnaires.
Seniority
Mid-level, hands-on IC