Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Rotating (Non-Exempt) (Non-Union)
Core
Ensuring insurance eligibility, benefit verification, and authorization processes are complete 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 / Insurance verification
Required skills
Insurance eligibility verification, benefit calculation, pre-authorization submission, CPT/ICD coding, patient liability assessment, HIPAA compliance, medical terminology, payer contract knowledge
Preferred skills
Experience with surgery/GI/chemo/infusion authorizations, mathematical calculation of out-of-pocket costs, physician office communication, Valor software proficiency
Technologies
Valor software, hospital registration systems, Internet 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 out-of-network or denied claims; Document authorization outcomes and collect patient balances; Complete Medicare Secondary Questionnaires.
Seniority
Mid-level, hands-on IC