FINANCIAL CLEARANCE SPECIALIST

StrideCare•Laurel, VA

22h•Remote

About The Position

The Financial Clearance team is responsible for managing all pre-appointment insurance processes including benefits verification, cost estimates, and prior authorizations.

Requirements

Positive and professional demeanor
Strong conflict resolution and problem-solving skills
Collaborative team player focused on achieving optimal outcomes
Excellent verbal and written communication skills across multiple channels
Thorough understanding of insurance coverage and policy requirements
Self-motivated with the ability to work independently
Flexible and adaptable; able to multitask effectively in a fast-paced environment
Perform well under pressure and manages time efficiently
High attention to detail and accuracy
Reliable and dependable work ethic
Open to feedback and demonstrates growth from constructive input
Proficient in Microsoft Office applications
Maintains strict compliance with HIPAA regulations
Perform other related duties as assigned.
Ability to sit for extended periods while working on a computer.
Manual dexterity to operate standard office equipment, including computers, phones, and fax machines.
Ability to occasionally lift and carry items weighing up to 20 pounds.
Sufficient visual acuity to perform tasks involving computer screens and paper documents.
Ability to move throughout the office to access files, equipment, and other necessary resources.
Maintain a dedicated workspace that is professional, organized, and free from distractions.
Have a reliable high-speed internet connection capable of supporting voice calls, data entry, and system usage without interruption.
Ensure workspace security and confidentiality, adhering to company policies on data protection and HIPAA privacy standards.

Nice To Haves

Medical Assistant Certification preferred

Responsibilities

Verify insurance benefits for all patients and accurately document details in Athena.
Understand insurance criteria and requirements for various treatments.
Review clinical records to confirm that criteria are met for authorization.
Initiate pre-authorization or predetermination requests with insurance companies, submitting all necessary clinical documentation via fax or portal.
Monitor the status of surgical reviews according to established protocols.
Document authorization request determinations following protocol.
Manage patient cases throughout the insurance review and authorization process.
Communicate any adverse determinations to the clinic staff promptly.
Create cost estimates for procedures, including both insurance-approved treatments and self-pay.
Maintain a log of surgical procedures ordered and those under insurance review.
Process incoming and outgoing faxes related to insurance authorizations.
Handle incoming and outgoing calls with patients and insurance representatives regarding surgical authorizations.
Contact patients to schedule procedures, review cost estimates, and provide pre/post-operative instructions for specific surgical procedures.
Communicate with the clinical team regarding questions on benefits, estimates, or authorizations.
Provide support and training assistance to team members when needed.