Financial Clearance Specialist II - Rev Cycle

UTHealth Houston•Houston, TX

2d•Remote

About The Position

The RCM Financial Clearance Specialist II is responsible for verifying insurance benefits and obtaining required authorizations and referrals to ensure financial clearance before patient services. This position supports new and established patients by ensuring accurate registration, eligibility, and authorization of services through effective communication with payers, providers, and patients. The Specialist also creates cost estimates and educates patients on financial responsibilities while maintaining compliance with internal policies and external regulations. UTHealth is seeking a highly motivated, experienced Financial Clearance Specialist II (Remote) to join our dynamic referral team. This team plays a critical role in ensuring that any referrals sent from outside hospitals to UTHealth physicians are processed efficiently and accurately. Working in a high-volume call center environment, you will be the first point of contact for patients referred to our doctors, ensuring a seamless experience from referral to scheduling.

Requirements

3 years experience in healthcare financial clearance, insurance verification, or a related revenue cycle role required
High School Diploma or equivalent required
Must live in Texas (TX). This is a Remote position, and you must reside in Texas
Must be able to attend any required onsite meetings

Nice To Haves

Associate's Degree in healthcare or business-related field preferred

Responsibilities

Verify medical insurance coverage for all referred patients.
Contact patients directly to obtain and confirm insurance information.
Coordinate referrals from external hospitals to UTHealth physicians.
Deliver exceptional customer service by guiding patients through the process until they are scheduled with their referred doctor.
Maintain efficiency and accuracy in a fast-paced, high-volume environment.
Collaborate with clinical and administrative teams to resolve any insurance or referral issues
Analyze benefit information and clinical documentation to ensure appropriate coverage and medical necessity per payer guidelines.
Perform all registration components from charge review to ensure accurate patient registration and compliance with payer requirements before claim submission.
Obtain prior authorizations for services per insurance policies and initiate Peer-to-Peer (P2P) reviews as needed.
Collaborate with clinical, scheduling, and financial teams for financial clearance.
Communicate benefits and cost estimates with patients.
Identify and update referral authorization numbers when applicable.
Accurately input and maintain insurance data in Epic based on real-time eligibility response or payor portals; ensure insurance plan selection aligns with the UT Managed Care Payer Plan Tool.
Identify and report trends in denials, payer issues, or workflow inefficiencies to support continuous improvement and leadership decision-making.
Maintain compliance with HOOP policies, HIPAA, and payer guidelines.
Performs other duties as assigned.