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

Keck Medicine of USC•Glendale, CA

2d•Onsite

About The Position

The Financial Clearance Specialist IV is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete. This role requires documentation of accurate insurance information and knowledge of insurance plans and authorization details to optimize reimbursement from payers. The specialist is also responsible for an extended understanding of the division of financial responsibility to accurately adjudicate Letters of Agreement, which helps streamline the claim management process and provides supporting documentation for appeals for non-contracted payers for both Professional and Hospital services. The Specialist IV must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Key duties include determining, communicating, and collecting patient liability prior to service, attempting to collect prior balances, conducting all transactions appropriately, and completing Medicare Secondary Questionnaires accurately. Compliance with HIPAA regulations is essential, and the specialist is expected to maintain professional development by attending workshops, in-services, and webinars to stay current on insurance rules and industry changes. Proficiency in understanding hospital and professional contracted versus non-contract payers, including language specific to covered services, and an extended understanding of payer DOFR and authorization submission for all service scopes in both hospital and professional settings are required. This position is part of Keck Medicine of USC, specifically at USC Verdugo Hills Hospital, a community hospital backed by an academic medical center, offering specialized care, research, and clinical trials.

Requirements

HS Diploma or GED
Minimum (3) years of experience in a hospital, health plan or Physician office environment with extensive knowledge of contracted and non-contracted payers, division of financial responsibility, including the ability to articulate benefit negotiations as required when adjudicating a letter of agreement with a non-contracted payer
Proficient in submission of authorization for all service types rendered within a hospital and/or professional setting
Knowledge of business office procedures
Knowledge of medical terminology and coding
Knowledge of grammar, spelling, and punctuation to type patient information
Extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting
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 working assigned shifts, overtime when approved
Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees
Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology
Must be able to understand and interpret patient liability and benefits for HMOs and all payer types
Proficient in interpreting and completing insurance verification process for all types of payers including HMO’s Commercial, Medi Cal and Senior Plans, Medi Cal, Medicare, PPO, POS, EPO, Capitation, Military, Workman Compensation

Responsibilities

Ensuring insurance eligibility, benefit verification, and the authorization processes are complete
Documenting accurate insurance information and utilizing knowledge of insurance plans and authorization details to optimize reimbursement from the payer
Accurately adjudicating Letters of Agreement to help streamline the claim management process
Securing mutually signed Letters of Agreement to provide legal documentation for appeals for all non-contracted payers for both Professional and Hospital services
Maintaining strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization
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 with the patient or patient’s representative
Maintaining compliance with HIPAA regulations as it pertains to the insurance processes
Maintaining professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations and industry changes