University of Southern California

Research university in Los Angeles, CA

Financial Clearance Specialist 3 - Prearrival

Clinical Support & Patient AdministrationUpdated on Nov 13

Full-timeLos Angeles, CA, USA$26 - $41.28 /hrIn-person

About the Job

Requirements

High school diploma or equivalent/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 clearly explain coverage to patients and providers is required.
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 for entering 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 and follow oral and written instructions 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 and understand the policy and procedure manual and information relevant to the position and hospital employees is required.
Fire Life Safety Training (LA City) is required for roles in LA City; if the applicant does not have a card upon hire, it must be obtained within 30 days and renewed before expiration.

Responsibilities

Obtain and verify insurance information and authorizations to ensure financial clearance of 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 insurance eligibility and benefits, financial responsibility, and required authorizations or pre-certifications.
Calculate and explain patient liability, including out-of-pocket costs, co-insurance, and deductibles, for Surgery, GI, chemotherapy/infusions, and imaging for invasive and non-invasive procedures in accordance with documentation guidelines.
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, GI, chemotherapy/infusions, and imaging for invasive and non-invasive procedures using Valor or payer websites, follow submission protocols, and 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 CPT and ICD coding; research payer medical policies and pre-certification requirements; follow up on routine message-center requests within 3–5 business days; scan authorizations into the appropriate patient account system and document outcomes.
Perform other duties as assigned.
Complete insurance eligibility, benefit verification, and authorization processes within payer timelines to help prevent denials or penalties; maintain accurate insurance and authorization records to support reimbursement.
Run eligibility checks and obtain benefit coverage information, including COBRA when applicable; confirm demographic information and ensure coordination-of-benefits and insurance-plan codes are accurate.
Verify coverage immediately for same-day and next-day inpatient and outpatient add-ons; determine whether pre-certification, pre-authorization, or referral is required and obtain it when applicable.
Communicate out-of-network issues with providers and the team, 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.
Complete transactions consistently and accurately, including the Medicare Secondary Questionnaire with the patient or representative.
Maintain compliance with HIPAA as it relates to insurance processes.
Attend workshops, in-services, and webinars to stay current on insurance rules, regulations, and industry changes.

Desired Qualifications

The ability to submit authorizations and explain full insurance benefits for Surgery, GI, imaging, chemotherapy, infusions, and invasive and non-invasive procedures is highly desirable.

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. Communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative. Maintain compliance with HIPAA regulations as it pertains to the insurance processes. Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry. Responsible in submitting authorizations for surgery, GI , Imaging chemotherapy, Infusions, invasive and non-invasive procedures, transplants, and all other services as required.

Departmental Specific Summary

Essential Duties

Responsible for obtaining insurance information/verification/authorization to ensure financial clearance of patient accounts. Updates both professional and / or hospital registration systems. Ensure all insurance plans are properly selected in all registration and scheduling information systems. Responsible for calling insurance or use Internet portals to obtain and document: a) Insurance eligibility and benefits, b) Financial responsibility, c) Authorization and / or Pre-Certification as required. (20%)
Responsible for understanding and articulating patient’s liability by performing mathematical calculations in understanding out of pocket, co-insurance and deductible calculations. Responsible for full calculations on all Surgery, GI, Chemo/Infusions, Imaging on non and invasive procedures by following the appropriate documentation standard guidelines. (20%)
Responsible for contacting Physician office when a patient’s services are denied, re-directed and or when a Peer to Peer is required. Communicate with physician offices regarding proposed admissions, special procedures, outpatient referrals and same day surgeries. (20%)
Responsible for submitting authorizations for Surgery, GI, Chemo/Infusions, Imaging on non and invasive procedures. Submits authorizations via the Valor software tool and or websites and follows the appropriate protocol when submitting authorizations. Responsible for clearing assigned worklists in any of the information systems (15%)
Responsible for completing Documentation of all authorization information is entered in all appropriate registration fields and follows the approved documentation standard guidelines. Submit pre-certification documentation to third party payers for authorization with correct CPT and ICD coding. Research payer medical policy requirements for treatment authorizations and understand process for submitting pre-certification requests. Follow up for routine requests from the message center are followed up on 3-5 business days consistently. Scan all authorizations into appropriate system under the respective patient accounts and document authorization outcomes in the registration system. (15%)
Perform all other duties as assigned. (10%)

Qualifications

Req High school or equivalent Or GED required.
Req 2 years Admitting/ insurance verification experience in a hospital, health plan or Physician office environment.
Req Broad experience in financial counseling and co-pay collections.
Req Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non- invasive procedures is highly desirable.
Req The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting.
Req Ability to interrupt patient’s insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers.
Req Strong problem solving customer skills.
Req Knowledge of business office procedures.
Req Knowledge of medical terminology and coding.
Req Knowledge of grammar, spelling, and punctuation to type patient information.
Req Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.
Req Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
Req Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.
Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.
Req Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.

Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

Keck Hospital of USC, a 343-bed acute care hospital, provides exceptional and innovative care for complex medical and surgical conditions across a wide range of specialties. The hospital’s world-renowned physicians deliver compassionate, customized, patient-centered care and treat the most acutely ill patients with highly innovative techniques and treatment plans. As a leading academic medical center, hundreds of clinical trials are currently taking place at Keck Hospital and its affiliated research institutions, giving patients access to novel and promising therapies that are generally not available elsewhere.
Every day at Keck Hospital, physicians, nurses and staff go beyond the science of exceptional medicine to bring patients breakthroughs in the art of caring. Join this world-class team providing highly specialized care, up-to-the-minute research, and innovative clinical trials.

The hourly rate range for this position is $26.00 - $41.28.
When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at [email protected]. Inquiries will be treated as confidential to the extent permitted by law.

If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser:

https://wd5.myworkday.com/usc/d/inst/1$9925/9925$151758.htmld

About the Company

University of Southern California

Research university in Los Angeles, CA

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.

Company size: Not listed
Company stage: Not listed
Total funding: Not listed
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Founded: Not listed

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