Financial Clearance Specialist

Shepherd Center•Atlanta, GA

About The Position

The Financial Clearance Specialist ensures patients are financially cleared before services by verifying insurance coverage, interpreting benefits, coordinating authorizations, delivering estimates, and providing financial counseling. The role is a key liaison between Patient Access Services, Patient Financial Services, and patients, helping reduce financial risk, support regulatory compliance, and improve patients’ financial experience. The specialist explains coverage and financial responsibility to patients and families, documents discussions and estimates in the EHR, supports payment arrangements and point-of-service collections, and helps patients access the Financial Assistance Program. The role also collaborates with internal departments and insurers to resolve complex coverage and financial issues, responds to patient inquiries, and provides registration support for outpatient clinics as needed.

Requirements

High school diploma or GED.
Three to five years of progressive experience in patient access, financial clearance, healthcare billing, or related revenue cycle functions; preferably in a hospital or physician enterprise.
Strong working knowledge of commercial, managed care, and governmental insurance plans.
Ability to independently interpret benefits, authorizations, and payer determinations.
Strong math aptitude and financial acumen.
Excellent written and verbal communication skills.
Proficiency with Epic and Microsoft Office tools.
Ability to manage sensitive financial conversations with professionalism and empathy.

Nice To Haves

Associate or bachelor’s degree preferred.
CPAR or CHAA preferred.
CHAM or HFMA CRCR a plus.

Responsibilities

Explain insurance benefits, coverage limitations, estimates, and financial responsibility for planned or received services to patients and families.
Interpret and explain benefits, explanations of benefits (EOBs), authorizations, denials, and payer determinations.
Accurately document benefit details, estimates, and financial discussions in the EHR.
Comply with CMS-required notices, the No Surprises Act, and price transparency requirements, including delivering and explaining patient estimates.
Establish and negotiate payment plans with patients in accordance with organizational policy.
Explain Shepherd Center’s Financial Assistance Program (FAP) and coordinate submission of required documentation.
Perform point-of-service collections, maintain cash drawer accuracy, process credit card transactions, and communicate with patients and guarantors about balances.
Collaborate with Insurance Verification Specialists and escalate complex coverage, authorization, or financial clearance issues as needed.
Receive escalations from Insurance Verification Specialists involving complex financial clearance scenarios.
Partner with Patient Financial Services, Case Management, Managed Care, and insurance carriers to resolve complex financial and coverage scenarios.
Meet with patients and families in clinics or at the bedside as required, demonstrating compassion, professionalism, and financial expertise.
Answer incoming calls and respond to voicemails and emails, routing patient inquiries appropriately and promptly.
Maintain working knowledge of registration workflows and provide cross-coverage support for outpatient clinics as needed.
Follow Center and departmental safety policies and report injuries, accidents, and other safety issues to the supervisor and in the occurrence notification system.
Monitor and ensure compliance with regulatory requirements, organizational standards, and applicable policies and procedures; identify potential risks and support their resolution.