Financial Clearance Specialist, Entry Level

About the position

This remote position involves processing patient, insurance, and financial clearance aspects for both scheduled and non-scheduled appointments. The role includes validating insurance and benefits, handling pre-certifications and prior authorizations, and managing scheduling and pre-registration tasks. The position requires effective communication with healthcare providers and patients to ensure smooth financial clearance processes.

Responsibilities
? Process administrative and financial components of financial clearance including validation of insurance/benefits and medical necessity validation.
,
? Handle routine and complex pre-certification and prior authorization requests.
,
? Schedule and pre-register patients, obtaining necessary demographic and insurance information.
,
? Initiate and track referrals, insurance verification, and authorizations for all encounters.
,
? Utilize third-party payer websites and real-time eligibility tools to retrieve coverage eligibility and benefit information.
,
? Work directly with physician's office staff to obtain clinical data needed for authorization.
,
? Input information online or call carriers to submit requests for authorization and document approval or pending status.
,
? Identify issues with referral/insurance verification processes and recommend solutions.
,
? Review and follow up on pending authorization requests.
,
? Coordinate and schedule services with providers and clinics.
,
? Research delays in service and discrepancies of orders.
,
? Assist management with denial issues by providing supporting data.
,
? Assist Medicare patients with the Lifetime Reserve process where applicable.
,
? Review previous day admissions to ensure payer notification upon observation or admission.
,
? Perform other duties as assigned.

Requirements
? High School Diploma or equivalent is required.
,
? Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.
,
? Knowledge of medical and insurance terminology.
,
? Knowledge of medical insurance plans, especially managed care plans.
,
? Ability to understand, interpret, evaluate, and resolve basic customer service issues.
,
? Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills.
,
? Intermediate analytical skills to resolve problems and provide information and assistance with financial clearance issues.
,
? Basic working knowledge of UB04 and Explanation of Benefits (EOB).
,
? Some knowledge of medical terminology and CPT/ICD-10 coding.

Nice-to-haves
? Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred.
,
? Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred.
,
? Knowledge of the Patient Access and hospital billing operations of Epic preferred.

Benefits
? Opportunity to grow professionally in a supportive and stimulating environment.
,
? Consistently named among the top 100 Best Places to Work in Maryland.

Apply Job!

For more such jobs please click here!