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

Keck Medicine of USC•Glendale, CA

1d•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 will 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, confirming demographic accuracy, and ensuring correct coordination of benefits (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, determining if pre-certification, pre-authorization, or a referral is needed, and obtaining them as applicable. The specialist will communicate with providers and the team regarding out-of-network issues, assess contracted and non-contracted payer concerns, and document outcomes. Additionally, the role involves determining, communicating, and collecting patient liability before services are rendered, attempting to collect prior balances, conducting all transactions appropriately, and accurately completing the Medicare Secondary Questionnaire. Maintaining compliance with HIPAA regulations related to insurance processes and pursuing professional development through workshops, in-services, and webinars to stay current on insurance rules, regulations, and industry changes are also essential. The role is responsible for submitting authorizations for surgery, GI, imaging, chemotherapy, infusions, invasive and non-invasive procedures, transplants, and all 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 explanation 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 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 the general information for all hospital employees.

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.
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.
Confirming all demographic information is correct.
Ensuring coordination of benefit (COB) and insurance plan codes are accurate.
Verifying insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons.
Determining if pre-certification, pre-authorization, or a referral is required and obtaining them.
Communicating with providers and team regarding out-of-network issues.
Assessing contracted and non-contracted payer issues and documenting outcomes.
Determining, communicating, and collecting patient liability prior to service and attempting to collect prior balances.
Conducting all transactions appropriately and consistently.
Completing Medicare Secondary Questionnaire accurately.
Maintaining compliance with HIPAA regulations.
Maintaining professional development by attending workshops, in-services, and webinars.
Submitting authorizations for surgery, GI, Imaging, chemotherapy, Infusions, invasive and non-invasive procedures, transplants, and all other services as required.