Financial Clearance Specialist III - Admitting - Full Time 8 Hour Variable Shift (Non Union)

University of Southern California•Glendale, CA

2d•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 both 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 running eligibility checks, securing full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirming demographic information accuracy, and ensuring correct coordination of benefit (COB) and insurance plan codes. The role requires verifying insurance coverage immediately for inpatient and outpatient accounts that are same-day or next-day additions. The specialist must determine if pre-certification, pre-authorization, or a referral is required by insurance companies and obtain them if necessary. This position involves communicating with providers and the team regarding out-of-network issues, assessing contracted and non-contracted payer issues, and documenting outcomes and next steps. Additionally, 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 with the patient or their representative. Maintaining compliance with HIPAA regulations related to insurance processes is crucial. The role also requires ongoing professional development through workshops, in-services, and webinars to stay updated on insurance rules, regulations, and industry changes. The specialist is responsible for submitting authorizations for surgery, GI, imaging, chemotherapy, infusions, invasive and non-invasive procedures, transplants, and all other services as required.

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 a hospital and medical business office setting.
Ability to interpret patient’s insurance coverage, identify services not covered, and provide clear explanations to patients and providers.
Strong problem-solving and customer service skills.
Knowledge of business office procedures.
Knowledge of medical terminology and coding.
Knowledge of grammar, spelling, and punctuation for typing 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 hospital employee information.

Nice To Haves

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.

Responsibilities

Ensuring insurance eligibility, benefit verification, and authorization processes are complete within insurance company time limits to prevent denials or penalties.
Documenting accurate insurance information and authorization details to optimize reimbursement.
Maintaining a strong working knowledge of insurance plans, contract requirements, and resources.
Running eligibility checks and securing full benefit coverage information with insurance companies and employers.
Confirming demographic information accuracy and ensuring correct COB and insurance plan codes.
Verifying insurance coverage immediately for same-day and next-day inpatient and outpatient accounts.
Determining and obtaining pre-certification, pre-authorization, or referrals when required by insurance companies.
Communicating with providers and team regarding out-of-network issues, assessing payer issues, and documenting outcomes.
Determining, communicating, and collecting patient liability prior to service and attempting to collect prior balances.
Completing the Medicare Secondary Questionnaire accurately.
Maintaining compliance with HIPAA regulations.
Submitting authorizations for various medical services including surgery, GI, imaging, chemotherapy, infusions, and procedures.