Financial Clearance & Insurance Authorization Specialist

UC San Diego Health; San Diego (CA); On-site; USD 65,000 - 86,000; Full time

Job summary

UC San Diego Health’s Revenue Cycle department is seeking a Financial Clearance and Insurance Authorization Specialist I to verify insurance eligibility and benefits coverage, and to secure pre-certification/authorization for inpatient and/or outpatient services. The role involves communicating with patients and providers and rescheduling as needed.

Responsibilities include providing estimated patient liability and ensuring accurate coverage information while collaborating with UCSD clinical

Qualifications

• Hospital pre-access or billing experience.
• 3+ years in hospital/professional services pre-access or billing in a multispecialty setting; college degree may substitute.
• Experience with insurance eligibility and benefits verification and obtaining pre-certification/authorization.
• Experience with insurance eligibility portals or similar applications and Epic or similar systems.
• Strong customer service, communication, and problem-resolution skills in healthcare settings.
• Knowledge of medical terminology, CPT, ICD-10, HCPCS, NDC, and modifiers affecting eligibility and reimbursement.
• Ability to interpret payer contract terms and benefits responses.
• Ability to estimate patient financial responsibility with deductibles, coinsurance, and non-covered benefits.
• Proficiency in Microsoft Office applications.

Responsibilities

• Verify insurance eligibility and benefits coverage.
• Obtain pre-certification/authorization for services.
• Communicate coverage status with patients and providers and reschedule services as needed.
• Provide and collect estimated patient liability amounts.

Skills

Hospital billing experience

Insurance eligibility verification

Pre-certification/authorization

Customer service

Effective communication

Microsoft Office proficiency

Epic or similar systems

Attention to detail

Understanding payer contracts

Education

College degree

Tools

Epic Registration/Scheduling/Referral apps

Microsoft Office (Outlook, Excel, Word)

Job description

UC San Diego Health’s Revenue Cycle department is seeking a Financial Clearance and Insurance Authorization Specialist I to verify insurance eligibility and benefits coverage, and to secure pre-certification/authorization for inpatient and/or outpatient services. The role involves communicating with patients and providers and rescheduling as needed.

Responsibilities include providing estimated patient liability and ensuring accurate coverage information while collaborating with UCSD clinical