Financial Clearance Specialist III - Revenue Cycle

UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. We are seeking a highly motivated, experienced Financial Clearance Specialist III (Remote) to join our dynamic referral team, which plays a critical role in ensuring referrals from outside hospitals to UTHealth physicians are processed efficiently and accurately.

About the Role

As the first point of contact for patients referred to our doctors, you will work in a high-volume call center environment, ensuring a seamless experience from referral to scheduling. This position is a key leader within the Revenue Cycle team, responsible for advanced-level insurance verification and authorization functions. The Senior Specialist demonstrates strong analytical ability to resolve complex authorization issues, identify trends, and support process improvements while acting as a resource and trainer for junior team members.

Responsibilities

• Verify medical insurance coverage for all referred patients.
• Contact patients directly to obtain and confirm insurance information.
• Coordinate referrals from external hospitals to UTHealth physicians.
• Deliver exceptional customer service by guiding patients through the process until they are scheduled with their referred doctor.
• Maintain efficiency and accuracy in a fast-paced, high-volume environment.
• Collaborate with clinical and administrative teams to resolve insurance or referral issues.
• Oversee comprehensive verification of insurance and benefit coverage, including accurate entry of patient demographics and insurance details.
• Secure and document prior authorizations and referrals based on clinical documentation and payer guidelines.
• Evaluate insurance policies for medical necessity and initiate Peer-to-Peer (P2P) reviews or appeals for escalated or denied cases.
• Ensure precise documentation of insurance data within Epic, including plan selection validation using the UT Payor Tool.
• Monitor and report trends in denials, payer issues, and workflow gaps.
• Consistently meet or exceed quality, productivity, and turnaround benchmarks as set by leadership.
• Communicate with patients regarding insurance coverage, authorization status, and financial responsibility, providing timely and accurate cost estimates.
• Collaborate with clinical, scheduling, and patient access teams to ensure coordinated and efficient service delivery.
• Provide guidance and training to junior team members on best practices in insurance verification, payer communications, and Epic documentation standards.
• Serve as a resource and role model within the team to promote continuous learning and operational consistency.
• Maintain strict compliance with HOOP policies, HIPAA regulations, and payer-specific requirements.
• Perform other duties as assigned.

Requirements

• High School Diploma or equivalent required; Associate's Degree in healthcare, business, or related field preferred.
• 5 years of experience in insurance authorization, verification, or healthcare financial clearance preferred.
• Proven experience resolving complex insurance cases and mentoring or training staff required.
• Must reside in Texas and be available for 2-4 weeks of onsite training in Houston (1851 Crosspoint Ave, 77054), as well as any required onsite meetings or additional training. Lodging and mileage reimbursement are not provided.
• Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Benefits

• 100% paid medical premiums for full-time employees.
• Generous time off (holidays, preventative leave day, vacation, and sick time—equating to around 37-38 days per year).li>
• Vacation accrual increases with longevity.
• Longevity Pay (monthly payments after two years of service).
• Retirement/pension plan.
• Free financial and legal counseling.
• Free mental health counseling services.
• Gym membership discounts and access to wellness programs.
• Employee discounts (entertainment, car rentals, cell phones, etc.).
• Resources for child and elder care.
• Additional work/life services and programs.

This position is security-sensitive pursuant to Texas Education Code 51.215 and Texas Government Code 411.094. Employees in this role may be subject to routine reviews regarding criminal history or connections to foreign adversaries to ensure the security and integrity of critical infrastructure.