Financial Clearance Specialist III - Revenue Cycle

UTHealth Houston•Houston, TX

1d•Remote

About The Position

UTHealth Houston is seeking a highly motivated, experienced Financial Clearance Specialist III (Remote) to join their 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. The RCM Financial Clearance Specialist III position is a key leader within the Revenue Cycle team, responsible for advanced-level insurance verification and authorization functions. This role ensures timely and accurate financial clearance of patient services by securing insurance benefits, prior authorizations, and referrals. The Senior Specialist demonstrates strong analytical ability to resolve complex authorization issues, identify trends, and support process improvements. Additionally, this position acts as a resource and trainer for junior team members, contributing to departmental performance and compliance.

Requirements

Must live in Texas (TX).
Must be able to attend any required onsite meetings.
Proven experience resolving complex insurance cases and mentoring or training staff required.

Nice To Haves

Associate's Degree in healthcare, business, or related field preferred.
5 years of experience in insurance authorization, verification, or healthcare financial clearance 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.
Oversee comprehensive verification of insurance and benefit coverage, including accurate entry of patient demographics and insurance details, inclusive of charge review functions.
Secure and document prior authorizations and referrals based on clinical documentation and payer guidelines.
Evaluate insurance policies for medical necessity and initiate Peer-to-Peer (P2P) reviews or appeals for escalated or denied cases.
Ensure precise documentation of insurance data within Epic, including plan selection validation using the UT Payor Tool.
Monitor and report trends in denials, payer issues, and workflow gaps.
Consistently meet or exceed quality, productivity, and turnaround benchmarks as set by leadership.
Effectively communicate with patients regarding insurance coverage, authorization status, and financial responsibility.
Provide timely and accurate cost estimates.
Collaborate with clinical, scheduling, and patient access teams to ensure coordinated and efficient service delivery.
Provide guidance and training to junior team members on best practices in insurance verification, payer communications, and Epic documentation standards.
Serve as a resource and role model within the team to promote continuous learning and operational consistency.
Maintain strict compliance with HOOP policies, HIPAA regulations, and payer-specific requirements.
Ensure all actions and documentation meet institutional, legal, and accreditation standards.
Performs other duties as assigned.

Benefits

100% paid medical premiums for our full-time employees
Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year)
The longer you stay, the more vacation you’ll accrue!
Longevity Pay (Monthly payments after two years of service)
Awesome retirement/pension plan!
Free financial and legal counseling
Free mental health counseling services
Gym membership discounts and access to wellness programs
Other employee discounts including entertainment, car rentals, cell phones, etc.
Resources for child and elder care