The Financial Clearance Specialist II is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Specialist II are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist II must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Individuals must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Specialist II must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Financial Clearance Specialist II must determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. The individual will be expected to communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Specialist II must also determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Representatives are to conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative. Specialist II must maintain compliance with HIPAA regulations as it pertains to the insurance processes. Representatives must maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry. Financial Clearance Specialist II is responsible for submitting authorizations for lab, diagnostic, and hospital ambulatory services and all other services as required.
Essential Duties:
- Responsible for completing all registration and insurance fields in hospital registration information system.
- Ensure all insurance plans are properly selected in all registration and scheduling information systems.
- Confirm benefits align with appropriate plan code selected in registration system assuring clean claim.
- Responsible for calling insurance or using Internet portals to obtain and document: a) Insurance eligibility and benefits, b) Financial responsibility, c) Authorization and/or Pre-Certification as required.
- Responsible for calculating patient liability on hospital and professional accounts and communicating/collecting the liability from the patient.
- Responsible for accurate submission of CPT and ICD 10 coding.
- Research payer medical policy requirements for treatment.
- Communicate with physician offices regarding proposed admissions, special procedures, outpatient referrals.
- Communication with medical/clinical staff and patients on authorization status/outcome and/or with Director on denied or disputed claims. Responsible for preparing pre-registration on scheduled procedures.
- Contact patients and/or Physician office as needed for additional information.
- Utilize fax applications as appropriate and perform document imaging as required.
- Scan all authorizations into appropriate system under the respective patient accounts and document outcomes in the registration system.
- Perform all other duties as assigned.
Required Qualifications:
- High school or equivalent or GED required.
- Minimum 1 year of experience in a hospital, health plan or Physician office environment with the ability to submit authorizations for office visits and laboratory services, perform insurance verification, call patient to conduct pre-registration, facilitate self-pay estimates.
- 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 have intermediate 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.
- Ability to read, understand, and follow oral and written instructions and establish and maintain effective working relationships with patients, employees, and the public.
- Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal 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.
Preferred Qualifications:
Required Licenses/Certifications:
- Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
The hourly rate range for this position is $19.00 - $29.77. 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 candidates 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.
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