Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

University of Southern California•Los Angeles, CA

2d•$25 - $40•Onsite

About The Position

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete within the timeframes set by insurance companies to prevent denials or penalties. This role involves documenting accurate insurance information and authorization details to optimize reimbursement from payers and patients. The specialist must maintain a strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Key duties include verifying insurance eligibility, obtaining full benefit coverage information, confirming demographic data, and ensuring accurate coordination of benefits and plan codes. The role requires verifying insurance coverage immediately for same-day and next-day inpatient and outpatient accounts. The specialist must determine if pre-certification, pre-authorization, or a referral is needed and obtain it if applicable. Communication with providers and the team regarding out-of-network issues, assessing contracted and non-contracted payer issues, and documenting outcomes are also crucial. The role involves determining, communicating, and collecting patient liability prior to service, as well as attempting to collect prior balances. All transactions must be conducted appropriately and consistently, and the Medicare Secondary Questionnaire must be completed accurately. Maintaining compliance with HIPAA regulations related to insurance processes and engaging in professional development through workshops, in-services, and webinars to stay updated on insurance rules, regulations, and industry changes are essential. The specialist is responsible for submitting authorizations for various services including surgery, GI, imaging, chemotherapy, infusions, invasive and non-invasive procedures, transplants, and any other required services.

Requirements

High school or equivalent Or GED required.
2 years Admitting/ insurance verification experience in a hospital, health plan or Physician office environment.
Broad experience in financial counseling and co-pay collections.
Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non- invasive procedures is highly desirable.
Extended ability to perform mathematical calculations.
Extensive experience in hospital and medical business office setting.
Ability to interpret patient’s insurance coverage, identify services that are not covered benefits, and provide clear explanations to patients and providers.
Strong problem-solving customer skills.
Knowledge of business office procedures.
Knowledge of medical terminology and coding.
Knowledge of grammar, spelling, and punctuation to type patient information.
Must be able to verify insurance and have advanced knowledge of both CPT codes and medical terminology.
Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
Ability to read, understand, and follow oral and written instructions.
Ability to establish and maintain effective working relationships with patients, employees, and the public.
Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.
Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and general information for all hospital employees.

Nice To Haves

Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

Responsibilities

Obtaining insurance information/verification/authorization to ensure financial clearance of patient accounts.
Updating professional and/or hospital registration systems.
Ensuring all insurance plans are properly selected in all registration and scheduling information systems.
Calling insurance companies or using Internet portals to obtain and document: a) Insurance eligibility and benefits, b) Financial responsibility, c) Authorization and / or Pre-Certification as required.
Understanding and articulating patient’s liability by performing mathematical calculations for out-of-pocket costs, co-insurance, and deductibles.
Performing full calculations for all Surgery, GI, Chemo/Infusions, and Imaging on non- and invasive procedures by following appropriate documentation standard guidelines.
Contacting Physician offices when a patient’s services are denied, re-directed, or when a Peer to Peer is required.
Communicating with physician offices regarding proposed admissions, special procedures, outpatient referrals, and same-day surgeries.
Submitting authorizations for Surgery, GI, Chemo/Infusions, and Imaging on non- and invasive procedures via the Valor software tool and/or websites, following appropriate protocol.
Clearing assigned worklists in any of the information systems.
Documenting all authorization information in appropriate registration fields and following approved documentation standard guidelines.
Submitting pre-certification documentation to third-party payers for authorization with correct CPT and ICD coding.
Researching payer medical policy requirements for treatment authorizations and understanding the process for submitting pre-certification requests.
Following up on routine requests from the message center within 3-5 business days consistently.
Scanning all authorizations into the appropriate system under the respective patient accounts and documenting authorization outcomes in the registration system.
Performing all other duties as assigned.