Financial Clearance Specialist IV - Admitting - Full Time 8 Hour Variable Shift

About the role

The Financial Clearance Specialist IV is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete. Documentation of accurate insurance information, knowledge of insurance plans and authorization details to optimize reimbursement from the payer are required.

Responsibilities

• Ensure insurance eligibility and benefit verification.
• Optimize reimbursement from the payer through accurate insurance information and knowledge of insurance plans.
• Secure mutually signed Letter of Agreement to streamline claim management process.
• Facilitate appropriate insurance verification and authorization by maintaining strong working knowledge of insurance plans, contract requirements, and resources.
• Determine, communicate, and collect patient liability prior to service.
• 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 stay updated on insurance rules and regulations.
• Interpret and complete insurance verification process for all types of payers including HMO’s, Commercial, Medi Cal, Medicare, PPO, POS, EPO, Capitation, Military, Workman Compensation.

Requirements

• Minimum (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, including the 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

• Minimum Education: HS Diploma or GED.
• Minimum Experience/Knowledge: Extensive knowledge of contracted and non-contracted payers, division of financial responsibility, including the 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.

Skills

• Strong working knowledge of insurance plans, contract requirements, and resources.
• Ability to articulate benefit negotiations as required when adjudicating a letter of agreement with a non-contracted payer.
• Proficiency 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.
• Ability to type patient information accurately.
• Extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting.

Benefits

As part of Keck Medicine of USC, USC Verdugo Hills Hospital offers highly-specialized care, up-to-the-minute research, and innovative clinical trials. The hospital is backed by an academic medical center with a 40-year legacy of personalized care from expert physicians, experienced nurses, and a dedicated staff.

Pay

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

Schedule

Financial Clearance Specialist IV must be capable of working assigned shifts, overtime when approved, and capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.