Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days

About the role

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and authorization processes are complete in the time allowed by insurance companies to prevent denials or penalties. This role involves documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient.

Responsibilities

• Ensure insurance eligibility and benefit verification, and secure full benefit coverage information (including COBRA when applicable).
• 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.
• Submit authorizations for surgery, GI, imaging, chemotherapy, infusions, invasive and non-invasive procedures, transplants, and all other services as required.

Qualifications

• High school diploma or equivalent.
• Two years of admitting or insurance verification experience in a hospital, health plan, or physician office environment.
• Broad experience in financial counseling and co-pay collections.
• Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non-invasive procedures.
• The ability to perform mathematical calculations, extensive experience in hospital and medical business office setting.
• Able to interrupt patient’s insurance coverage, identify services that are not covered benefit, and provide clear explanations to patients and providers.
• Strong problem-solving customer skills.
• Knowledge of business office procedures.
• Knowledge of medical terminology and coding.
• Knowledge of grammar, spelling, and punctuation to type patient information.
• Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.
• Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
• Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.
• Capable of reading, understanding, and following oral and written instructions and establishing and maintaining effective working relationships with patients, employees, and the public.
• Knowledge of federal, state, and local laws, contractual stipulations, grant funding, and external market and organizational considerations.

Benefits

The University of Southern California offers a competitive compensation package including a range of benefits such as health insurance, retirement plans, and paid time off.

Pay

The hourly rate range for this position is $25.00 - $39.69.

Schedule

The Financial Clearance Specialist III works full-time on an 8-hour schedule.