Senior Financial Clearance Specialist, Hybrid

University of Maryland Medical System • Linthicum Heights, MD

1d • Hybrid

About The Position

This position is responsible for coordinating the administrative and financial components of financial clearance. This includes validating insurance/benefits, performing routine and complex pre-certification and prior-authorization, scheduling/pre-registration, providing patient benefit and cost estimates, and pre-collecting out-of-pocket cost share and financial assistance referrals. The role also involves managing service line and complex multi-payer insurance verification, benefit eligibility validation, and prior authorizations. Additionally, the specialist will perform root cause analysis on no authorization denials, cross-train and guide the team, maintain communication with patients and families, and collaborate with program and department contacts. Developing denial mitigation strategies with various departments is also a key responsibility.

Requirements

• At least 2 years of healthcare revenue cycle, patient access, hospital or medical office experience. General customer service, retail or non-healthcare call center work does not count.
• Hands-on experience with insurance verification and prior authorization or pre-certification: checking eligibility and benefits on payer websites or real-time eligibility tools, and submitting and following up on auth requests with payers.
• Working knowledge of insurance plans, especially managed care (HMO/PPO, Medicare, Medicaid MCOs), and of benefit terms like copays, deductibles and coinsurance.
• Knows medical terminology and has basic familiarity with CPT and ICD-10 codes.

Nice To Haves

• Epic experience, especially Prelude/Cadence (registration and scheduling) or Epic authorization work queues
• Experience getting clinical documentation from physician offices to support auth requests
• Experience with patient cost estimates, collecting out-of-pocket costs up front, or financial assistance referrals
• Can read a UB-04 and an EOB

Responsibilities

• Coordinates administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out-of-pocket cost share and financial assistance referrals.
• Manages service line, and/or complex multi-payer insurance verification and benefit eligibility validation and prior authorizations, including obtaining and completing documentation for pre-certification and referrals/authorizations.
• Performs root cause analysis on no authorization denials.
• Cross trains and provides guidance to team of financial clearance specialists in day-to-day operations
• Maintains regular communication and follow-up with patients and families to keep them informed of clearance and self-pay matters.
• Maintains regular communication and follow-up with program and department contacts regarding pending insurance, coverage, and other payment-related matters.
• Develops denial mitigation strategies with staff in registration, patient financial services, and clinical areas, as applicable.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed