Patient Financial Clearance Specialist

U.S. Dermatology Partners•Silver Spring, MD

2d•$18 - $23•Onsite

About The Position

The Patient Financial Clearance Specialist verifies patient insurance eligibility and benefits and follows US Dermatology Partners’ policies and procedures for verification timelines and out-of-network scheduling. The role maintains strict confidentiality for patient accounts and handles short- and long-term financial clearance projects as assigned. The specialist ensures patient records contain sufficient information for accurate verification, selects appropriate primary and additional payers, and sets up coordination of benefits in NextGen. Using systems such as Rivet and Availity, payer portals, and insurer contacts, the specialist obtains eligibility, benefit, referral, and authorization information. The role also verifies coverage for reference labs, consulting physicians, outside second-opinion consultations, and outside testing; obtains required authorizations or referrals; and records complete, accurate information in NextGen. The specialist documents verification findings, contacts patients before service when applicable to explain estimated financial responsibility and USDP financial policies, and follows out-of-network and self-pay procedures. Additional duties include resolving insurance-related claim edits and tasks, tracking and reporting trends and repeat tasks to the manager, supporting workflow optimization, and following safety policies while contributing to high-quality service. The position works in a high-volume environment and has no supervisory responsibilities.

Requirements

At least 3 years of work experience in medical insurance verification and/or patient financial clearance.
At least 3 years of work experience initiating and following up on PCP referrals and/or prior authorizations.
Familiarity with individual payer guidelines and the collection of in-office payments, deductibles, co-pays, and co-insurance.
Knowledge of payer contracts and guidelines, including Medicare, commercial, and other government contracts.
Detail-oriented, professional, and reliable.
Management and organizational skills to support leadership of this function.
Ability to follow or provide verbal and written instructions, with sufficient grammar and spelling skills to avoid mistakes or misinterpretations.
Ability to work successfully under tight timeframes.
Interpersonal skills to support customer service, functional, and team needs.
Ability to communicate effectively in English, verbally and in writing.
Intermediate mathematical and/or analytical ability, including complex problem solving.
Intermediate computer-operation skills.
Experience with Microsoft Excel and Word.
Knowledge of systems related to the job function.
Knowledge of state and federal regulations and a general understanding of HIPAA guidelines.

Nice To Haves

Experience with NextGen, Availity, and Rivet.
Knowledge of coordination of benefits.

Responsibilities

Verify that patient records contain sufficient information for accurate insurance eligibility and benefit verification.
Determine whether secondary or tertiary insurance should be added and select the appropriate primary payer.
Calculate and configure coordination of benefits in NextGen.
Use Rivet, Availity, payer portals, and insurer contacts to obtain eligibility, benefit, referral, and authorization information.
Verify insurance coverage for reference labs, consulting physicians, outside second-opinion consultations, and outside testing.
Collect prior authorization or confirm eligibility for additional testing, particularly for HMO and narrow-network plans.
Enter patient insurance information into NextGen with the appropriate payer and financial class.
Follow policies for accepting out-of-network payers and notify patients promptly when applicable.
Ensure each patient’s insurance verification is complete and accurate.
Document verification findings in patient accounts and communicate estimated co-insurance, co-pay, and deductible amounts to patients before the date of service when applicable.
Contact patients before service to review their financial responsibility in accordance with CMS Conditions for Coverage guidelines.
Check insurer-approved procedure lists and medical policies; notify patients when procedures are not payable and explain options under USDP’s Self-Pay agreement.
Obtain authorizations and referrals from insurance companies or physician offices, verify their accuracy, and enter them into NextGen.
Communicate USDP’s financial policy to patients when applicable.
Resolve claim edits related to authorizations, demographics, and insurance.
Track and report claim-edit trends and repeat patient insurance-related tasks to the manager.
Work and resolve patient insurance-related tasks.
Assist with workflow optimization by piloting new procedures, applications, and policies, and track and report findings to the manager.
Follow safety policies and procedures while supporting high-quality service and effective communication with clients and patients.
Perform other duties necessary or in the organization’s best interest.