Financial Clearance & Authorization Specialist

University of Maryland Medical System Corporation; Baltimore (MD); On-site; USD 40,000 - 60,000; Full time

Job summary

University of Maryland Medical System Corporation in Baltimore seeks a Financial Clearance Specialist to manage patient, insurance and financial clearance for scheduled and unscheduled appointments, including verification of benefits and prior authorizations.

The role involves triaging routine financial clearance work, initiating referrals, utilizing payer portals, and coordinating with clinics to ensure timely authorizations and accurate cost estimates.

Qualifications

• High School Diploma or equivalent required.
• Minimum two years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.
• Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred.

Responsibilities

• Processes administrative and financial components of financial clearance including validation of insurance/benefits, medical necessity validation, pre-certification and prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share.
• Initiates and tracks referrals, insurance verification and authorizations for all encounters.
• Uses payer portals and real-time eligibility tools to retrieve coverage eligibility and benefit information, including copays and deductibles.
• Collaborates with physician office staff to obtain clinical data needed for carrier authorization.
• Inputs information online or via phone to obtain authorization and documents approval or pending status.
• Identifies issues with referral/insurance verification processes and recommends improvements.
• Reviews and follows up on pending authorization requests.
• Coordinates and schedules services with providers and clinics.
• Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing.
• Develops rapport with inter-departmental personnel and assists Medicare patients with Lifetime Reserve when applicable.
• Performs other duties as assigned.

Skills

Insurance terminology

Customer service

Communication

Problem solving

Process improvement

Education

High School Diploma or equivalent

Tools

Epic

Job description

University of Maryland Medical System Corporation in Baltimore seeks a Financial Clearance Specialist to manage patient, insurance and financial clearance for scheduled and unscheduled appointments, including verification of benefits and prior authorizations.

The role involves triaging routine financial clearance work, initiating referrals, utilizing payer portals, and coordinating with clinics to ensure timely authorizations and accurate cost estimates.