U

University of Southern California

Research university in Los Angeles, CA

Financial Clearance Specialist 3 - Prearrival

Full-Time
$26 - $41.28/hr
Junior
Los Angeles, CA, USA
In Person
Medical, Clinical & VeterinaryClinical Support & Patient Administration

About the job

Requirements
  • High school diploma or equivalent, or GED, is required.
  • Two years of admitting or insurance verification experience in a hospital, health plan, or physician office environment is required.
  • Broad experience in financial counseling and co-pay collections is required.
  • The ability to perform mathematical calculations and extensive experience in a hospital and medical business office setting are required.
  • The ability to interpret patient insurance coverage, identify services that are not covered benefits, and explain them clearly to patients and providers is required.
  • Strong problem-solving and customer-service skills are required.
  • Knowledge of business office procedures, medical terminology, and coding is required.
  • Knowledge of grammar, spelling, and punctuation sufficient to type patient information is required.
  • The ability to verify insurance and advanced knowledge of CPT codes and medical terminology are required.
  • The ability to understand and interpret patient liability and benefits for HMOs and all payer types is required.
  • The ability to read, understand, and follow oral and written instructions, and to establish and maintain effective working relationships with patients, employees, and the public, is required.
  • Time management, organizational, research and analytical, negotiation, written and verbal communication, and interpersonal skills are required.
  • The ability to read the policy and procedure manual and understand information pertaining to specific job duties and general information for hospital employees is required.
  • LA City Fire Life Safety Training is required; if the employee does not have a card upon hire, it must be obtained within 30 days and maintained through renewal before expiration.
Responsibilities
  • Ensure insurance eligibility, benefit verification, and authorization processes are completed within insurer deadlines to prevent denials or penalties.
  • Document accurate insurance information and authorization details to optimize reimbursement from payers and patients.
  • Maintain working knowledge of insurance plans, contract requirements, and resources to facilitate insurance verification and authorization.
  • Run eligibility checks and obtain full benefit coverage information, including COBRA when applicable; confirm demographic information and the accuracy of coordination-of-benefits and insurance plan codes.
  • Immediately verify insurance coverage for same-day and next-day inpatient and outpatient add-ons.
  • Determine whether pre-certification, pre-authorization, or a referral is required and obtain it when applicable.
  • Communicate with providers and the team about out-of-network issues; assess contracted and non-contracted payer issues, and document outcomes and next steps.
  • Determine, communicate, and collect patient liability before service and attempt to collect prior balances.
  • Conduct transactions consistently and complete the Medicare Secondary Questionnaire accurately with the patient or representative.
  • Maintain compliance with HIPAA regulations in insurance processes.
  • Attend workshops, in-services, and webinars to stay current on insurance rules, regulations, and industry changes.
  • Submit authorizations for surgery, GI, imaging, chemotherapy, infusions, invasive and non-invasive procedures, transplants, and other services as required.
  • Obtain insurance information, verification, and authorization to financially clear patient accounts; update professional and/or hospital registration systems and ensure insurance plans are correctly selected in registration and scheduling systems.
  • Contact insurers or use internet portals to obtain and document eligibility and benefits, financial responsibility, and authorization or pre-certification as required.
  • Calculate patient out-of-pocket costs, co-insurance, deductibles, and liability for surgery, GI, chemotherapy/infusions, imaging, and invasive and non-invasive procedures in accordance with documentation guidelines.
  • Contact physician offices when services are denied or redirected, or when peer-to-peer review is required; communicate about proposed admissions, special procedures, outpatient referrals, and same-day surgeries.
  • Submit authorizations for surgery, GI, chemotherapy/infusions, imaging, and invasive and non-invasive procedures using the Valor software tool and/or websites, follow submission protocols, and clear assigned worklists in information systems.
  • Enter authorization information in all appropriate registration fields according to documentation guidelines; submit pre-certification documentation to third-party payers with correct CPT and ICD coding, research payer medical-policy requirements, and follow the pre-certification request process.
  • Follow up consistently within 3–5 business days on routine message-center requests, scan authorizations into the appropriate system under the respective patient accounts, and document authorization outcomes in the registration system.
  • Perform other duties as assigned.
Desired Qualifications
  • The ability to submit authorizations and articulate full insurance benefits for surgery, GI, imaging, chemotherapy, infusions, and invasive and non-invasive procedures is highly desirable.

About the company

U

University of Southern California

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The University of Southern California is a private research university with academic programs across the arts, sciences, business, engineering, law, health, and other professional fields.

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