Financial Clearance Specialist

Job Responsibilities

• Provide expert guidance to patients and families by explaining insurance benefits, coverage limitations, estimates, and financial responsibility for planned or received services
• Interpret and explain benefits, explanations of benefits (EOBs), authorizations, denials, and payer determinations to patients and families
• Document benefit details, estimates, and financial discussions accurately within the EHR
• Ensure compliance with CMS-required notices, the No Surprises Act, and price transparency requirements, including delivery and explanation of patient estimates
• Establish and negotiate payment plans with patients as appropriate and in accordance with organizational policy
• Serve as the first point of contact for explaining Shepherd Center’s Financial Assistance Program (FAP) and coordinate submission of required documentation
• Perform POS collections, maintain cash drawer accuracy, process credit card transactions, and communicate effectively with patients and guarantors regarding balances
• Collaborate closely with Insurance Verification Specialists, escalating complex coverage, authorization, or financial clearance issues as needed
• Partner with Patient Financial Services, Case Management, Managed Care, and insurance carriers to resolve complex financial and coverage scenarios
• Meet with patients and families in clinics or at the bedside as required, demonstrating compassion, professionalism, and financial expertise
• Answer incoming calls, respond to voicemails and emails, and route patient inquiries appropriately in a timely manner
• Maintain working knowledge of registration workflows and provide cross-coverage support for outpatient clinics as needed

Required Minimum Skills

• Strong working knowledge of commercial, managed care, and governmental insurance plans
• Demonstrated ability to interpret benefits, authorizations, and payer determinations independently
• Strong math aptitude and financial acumen
• Excellent written and verbal communication skills
• Proficiency with Epic and Microsoft Office tools
• Ability to manage sensitive financial conversations with professionalism and empathy