Financial Clearance Specialist, Outpatient Oncology

University of Maryland Medical System-posted 10 days ago
$19 - $26/Yr
Full-time • Entry Level
Glen Burnie, MD
1,001-5,000 employees
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General Summary: Under general supervision, responsible for processing the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including, validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. Responsible for triaging routine financial clearance work.

  • Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals.
  • Initiates and tracks referrals, insurance verification and authorizations for all encounters.
  • Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles.
  • Works directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier.
  • Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status.
  • Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements.
  • Reviews and follows up on pending authorization requests.
  • Coordinates and schedules services with providers and clinics.
  • Researches delays in service and discrepancies of orders.
  • Assists management with denial issues by providing supporting data.
  • Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing.
  • Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services.
  • Assists Medicare patients with the Lifetime Reserve process where applicable.
  • Reviews previous day admissions to ensure payer notification upon observation or admission.
  • Must be willing to travel between facilities as needed (applies to specific UMMS Facilities).
  • Performs other duties as assigned.
  • High School Diploma or equivalent is required.
  • Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.
  • Knowledge of medical and insurance terminology.
  • Knowledge of medical insurance plans, especially manage care plans.
  • Ability to understand, interpret, evaluate, and resolve basic customer service issues.
  • Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.
  • Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues.
  • Basic working knowledge of UB04 and Explanation of Benefits (EOB).
  • Some knowledge of medical terminology and CPT/ICD-10 coding.
  • Demonstrate dependability, critical thinking, and creativity and problem-solving abilities.
  • Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred.
  • Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred.
  • Knowledge of the Patient Access and hospital billing operations of Epic preferred.
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