Financial Clearance Specialist III - Revenue Cycle

UTHealth Houston•Houston, TX

1d•Onsite

About The Position

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

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

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.