Full-Time
Financial Clearance Specialist 3
Prearrival
University of Southern California
Research university in Los Angeles, CA
Compensation Overview
$26 - $41.28/hr
Los Angeles, CA, USA
In Person
Category
 Accounting (1) |
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Required Skills
Medical Terminology
HIPAA
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Requirements
- A high school diploma or equivalent, or a General Educational Development certificate, is required.
- Two years of admitting or insurance verification experience in a hospital, health plan, or physician office environment are required.
- Broad experience in financial counseling and copay collections is required.
- The ability to submit authorizations and articulate full insurance benefits for surgery, gastrointestinal services, imaging, chemotherapy, infusions, and invasive and non-invasive procedures 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 provide clear explanations 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 to type patient information is required.
- The ability to verify insurance and advanced knowledge of Current Procedural Terminology codes and medical terminology are required.
- The ability to understand and interpret patient liability and benefits for health maintenance organizations and all payer types is required.
- The ability to read, understand, and follow oral and written instructions and establish and maintain effective working relationships with patients, employees, and the public is required.
- Excellent 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 hospital employee information is required.
- Fire Life Safety Training from the City of Los Angeles is required; if no card is held upon hire, it must be obtained within 30 days and renewed before expiration.
Responsibilities
- Obtain insurance information, verification, and authorization to ensure financial clearance of patient accounts.
- Update professional and hospital registration systems and ensure insurance plans are properly selected in registration and scheduling systems.
- Contact insurance companies or use internet portals to obtain and document eligibility and benefits, financial responsibility, and authorization or pre-certification requirements.
- Calculate patient liability, out-of-pocket amounts, coinsurance, and deductibles for surgery, gastrointestinal services, chemotherapy and infusions, imaging, and invasive and non-invasive procedures.
- Contact physician offices when services are denied or redirected or when a peer-to-peer review is required.
- Communicate with physician offices regarding proposed admissions, special procedures, outpatient referrals, and same-day surgeries.
- Submit authorizations for surgery, gastrointestinal services, chemotherapy and infusions, imaging, invasive and non-invasive procedures, transplants, and other required services using the Valor software tool or payer websites.
- Clear assigned worklists in information systems.
- Enter authorization information in appropriate registration fields according to documentation standards.
- Submit pre-certification documentation to third-party payers with correct Current Procedural Terminology and International Classification of Diseases coding.
- Research payer medical-policy requirements for treatment authorizations and follow the process for submitting pre-certification requests.
- Follow up on routine message-center requests within three to five business days.
- Scan authorizations into the appropriate system under the respective patient accounts and document authorization outcomes in the registration system.
- Ensure insurance eligibility, benefit verification, and authorization processes are completed within insurers' allowed timeframes to prevent denials or penalties.
- Document accurate insurance information and authorization details to optimize reimbursement from payers and patients.
- Verify coverage immediately for same-day and next-day inpatient and outpatient add-ons.
- Determine whether pre-certification, pre-authorization, or referrals are required and obtain them when applicable.
- Communicate with providers and the team regarding out-of-network issues and assess contracted and non-contracted payer issues, outcomes, and next steps.
- Determine, communicate, and collect patient liability before service and attempt to collect prior balances.
- Complete the Medicare Secondary Questionnaire accurately with the patient or patient's representative.
- Maintain compliance with Health Insurance Portability and Accountability Act regulations as they pertain to insurance processes.
- Attend workshops, in-services, and webinars to remain current on insurance rules, regulations, and industry changes.
- Perform other duties as assigned.
Desired Qualifications
- Ability to submit authorizations and articulate full insurance benefits for surgery, gastrointestinal services, imaging, chemotherapy, infusions, and invasive and non-invasive procedures is highly desirable.
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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