Financial Clearance Specialist

University of Maryland Medical System•Baltimore, MD

About The Position

Under general supervision, the Financial Clearance Specialist processes patient, insurance, and financial clearance for scheduled and non-scheduled appointments. The role includes validating insurance coverage and benefits, handling routine and complex pre-certifications and prior authorizations, scheduling and pre-registration, and triaging routine financial clearance work. The specialist also supports patient benefit and cost estimates, pre-collection of out-of-pocket costs, and financial assistance referrals. The position coordinates with patients, physician offices, providers, clinics, ancillary departments, and financial services to obtain information, arrange services, resolve clearance issues, and support authorization and billing processes. The job description notes that travel between facilities may be required for specific UMMS facilities.

Requirements

High school diploma or equivalent.
At least two years of experience in healthcare revenue cycle, a medical office, a hospital, patient access, or a related area.
Knowledge of medical and insurance terminology.
Knowledge of medical insurance plans, especially managed care plans.
Ability to understand, interpret, evaluate, and resolve basic customer service issues.
Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills for interacting with peers, superiors, patients, healthcare team members, and external agencies.
Intermediate analytical skills to resolve problems and provide patients and referring physicians with information and assistance on financial clearance issues.
Basic working knowledge of UB04 and Explanation of Benefits (EOB).
Some knowledge of medical terminology and CPT/ICD-10 coding.
Dependability, critical thinking, creativity, and problem-solving abilities.

Nice To Haves

Experience in healthcare registration, scheduling, insurance referral, and authorization processes.
Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, and federal, state, and legal statutes.
Knowledge of Patient Access and hospital billing operations in Epic.

Responsibilities

Process administrative and financial clearance components, including insurance and benefit validation, medical necessity validation, pre-certification, prior authorization, scheduling, pre-registration, benefit and cost estimates, out-of-pocket cost pre-collection, and financial assistance referrals.
Initiate and track referrals, insurance verification, and authorizations for encounters.
Use payer websites, real-time eligibility tools, and telephone calls to retrieve coverage eligibility, authorization requirements, and benefit information, including copays and deductibles.
Work with physician office staff to obtain clinical data needed for carrier authorization.
Submit authorization requests online or by telephone, provide clinical backup for tests, and document approval or pending status.
Identify issues in referral and insurance verification processes, analyze current processes, and recommend solutions and improvements.
Review and follow up on pending authorization requests.
Coordinate and schedule services with providers and clinics.
Research service delays and order discrepancies.
Assist management with denial issues by providing supporting data.
Pre-register patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals, and bill processing.
Maintain working relationships with interdepartmental personnel, including ancillary departments, physician offices, and financial services.
Assist Medicare patients with the Lifetime Reserve process where applicable.
Review previous-day admissions to ensure payer notification for observation or admission.
Travel between facilities as needed where applicable to specific UMMS facilities.
Perform other duties as assigned.