Financial Clearance Specialist - Hybrid

City of Hope•Irwindale, CA

11d•Hybrid

About The Position

The Financial Clearance Specialist supports referral coordination, pre-registration, and customer service for City of Hope patients. The role identifies and obtains insurance authorizations for services, procedures, testing, chemotherapy, and surgery; reviews outpatient charts; prepares payer forms and authorization or denial-appeal correspondence; tracks pending utilization-review cases; and keeps relevant case managers updated. The specialist also explains insurance policies to patients and maintains records for managed care patients. The position performs pre-registration and financial-clearance activities for all patient types, including gathering and verifying demographic, clinical, financial, and insurance information, confirming eligibility and consent forms, estimating patient liability, and collecting patient or guarantor responsibilities. It works with patients, payers, physicians, and internal departments to resolve issues, and refers uninsured or underinsured patients to financial counselors for assistance or program screening. The specialist also notifies the contracting department when a non-contracted insurer may require a Letter of Agreement. The role provides courteous assistance to patients and visitors, serves as a liaison to support staff, and communicates with colleagues, physicians, providers, leaders, and other employees. It manages changing priorities under pressure, responds professionally to difficult situations, takes prompt action on high-priority matters, escalates unresolved issues affecting patient care, and answers calls and pages from doctors, patients, employees, and insurance companies. The schedule is hybrid, Monday through Friday, 8:30 a.m. to 5:00 p.m.

Requirements

High school diploma or equivalent GED.
Three years of related healthcare pre-registration or referral experience.
Medical terminology experience.
Electronic medical record experience.

Nice To Haves

At least two years of front-desk oncology practice experience registering patients and scheduling appointments.
EPIC EMR experience.

Responsibilities

Identify insurers that require prior authorization and obtain authorization for services, procedures, testing, chemotherapy, and surgery.
Review outpatient charts and report information to third-party payors.
Prepare required forms and correspondence to request treatment authorization or appeal denials.
Work pending utilization-review cases and pursue authorization for the following day, including emergent authorizations for walk-in patients.
Verify precertification requirements with insurance companies and document them.
Educate patients about their insurance policies and maintain current records on managed care patients.
Keep Case Managers updated on BMO and BMT patients.
Perform pre-registration activities, including obtaining or verifying demographic, clinical, financial, and insurance information, service eligibility, consent forms, and patient or guarantor information.
Contact patients, payers, and departments to confirm or verify insurance and demographic information.
Refer patients to financial counselors to resolve insurance or payment issues and to screen for charity, financial assistance, or government programs when uninsured or underinsured.
Estimate patient liability, notify patients of expected financial responsibility, and collect patient or guarantor liabilities.
Notify the contracting department about patients with non-contracted insurance so it can prepare a Letter of Agreement when appropriate, and inform patients of approval status.
Perform financial-clearance activities for all patient types and communicate frequently with patients, families, guarantors, physicians, office staff, the medical center, and payors.
Greet and assist patients and visitors, serve as a liaison between patients and support staff, and develop effective working relationships across the organization.
Manage multiple changing priorities while maintaining exceptional service and composure under pressure.
Recognize high-priority situations and take appropriate immediate action.
Communicate with service-delivery and other departments to resolve issues affecting patient care, escalating unresolved issues according to departmental guidelines.
Answer daily phone calls and pages from doctors, patients, employees, and insurance companies.