Financial Clearance Specialist IV - Admitting - Full Time 8 Hour Variable Shift (Non Union)

About the role

The Financial Clearance Specialist IV is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete. This includes documentation of accurate insurance information, knowledge of insurance plans and authorization details to optimize reimbursement from the payer, and extended understanding of division of financial responsibility to accurately adjudicate Letters of Agreement.

Responsibilities

• Optimize reimbursement from payers by securing the mutually signed Letter of Agreement, which provides legal documentation outlining the intent of both parties and necessary supporting documents for appeals.
• Facilitate appropriate insurance verification and authorization by maintaining strong working knowledge of insurance plans, contract requirements, and resources.
• Communicate and collect patient liability before service and attempt to collect prior balances.
• Complete Medicare Secondary Questionnaire accurately with the patient or patient's representative.
• Maintain compliance with HIPAA regulations as it pertains to insurance processes.
• Attend workshops, in-services, and webinars to stay updated on insurance rules and regulations in addition to industry changes.
• Interpret and complete insurance verification process for all types of payers including HMOs, commercial, Medi-Cal, Medicare, PPO, POS, EPO, capitation, military, and workman compensation.

Requirements

• Minimum Education: HS Diploma or GED
• Minimum Experience/Knowledge: 3 years of experience in a hospital, health plan, or physician office environment with extensive knowledge of contracted and non-contracted payers, division of financial responsibility, and ability to articulate benefit negotiations as required when adjudicating a letter of agreement with a non-contracted payer.
• Proficient in submission of authorization for all service types rendered within a hospital and/or professional setting.
• Knowledge of business office procedures.
• Knowledge of medical terminology and coding.
• Knowledge of grammar, spelling, and punctuation to type patient information.
• Extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting.

Qualifications

• Strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization.
• Ability to read, understand, and follow oral and written instructions.
• Effective communication (written and verbal) and interpersonal skills.
• Excellent time management, organizational skills, research/analytical skills, negotiation, and communication (written and verbal) skills.
• Capable of working assigned shifts, overtime when approved.
• Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.
• Proficient in interpreting and completing insurance verification process for all types of payers including HMOs, commercial, Medi-Cal, Medicare, PPO, POS, EPO, capitation, military, and workman compensation.

Skills

• Proficiency in hospital and professional contracted versus non-contracted payers including interpretation of language specific to covered services.
• Extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting.

Benefits

Join this world-class team providing highly-specialized care, up-to-the-minute research, and innovative clinical trials at USC Verdugo Hills Hospital, the only community hospital in the Foothills area of Los Angeles backed by an academic medical center. The hourly rate range for this position is $26.00 - $34.00.

Pay

The hourly rate range for this position is $26.00 - $34.00.

Schedule

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.