Financial Clearance Specialist

University of Maryland Medical System; Baltimore (MD); On-site; Full time

Job summary

An established industry player is seeking a dedicated professional to join their team in the healthcare sector. This role involves managing patient insurance and financial clearance processes, ensuring smooth operations for scheduled and non-scheduled appointments. The ideal candidate will possess strong communication and analytical skills, with a focus on providing exceptional customer service. Join a collaborative environment where your contributions will directly impact patient care and operational efficiency. If you are passionate about making a difference in healthcare, this opportunity is perfect for you!

Qualifications

• 2+ years of experience in healthcare revenue cycle or related field.
• Knowledge of medical insurance plans and terminology is essential.

Responsibilities

• Process patient insurance and financial clearance for appointments.
• Coordinate referrals and authorizations with providers and clinics.

Skills

Medical and insurance terminology

Customer service skills

Analytical skills

Communication skills

Problem-solving abilities

Education

High School Diploma or equivalent

Tools

Epic

Job description

3 days ago Be among the first 25 applicants

Company Description
At University of Maryland Charles Regional Medical Center (UM CRMC), our talented and diverse groups of professionals represent our strength. Through teamwork and a collaborative work environment, we proudly serve our patients and our community with unwavering commitment. It’s our passion for people that motivates us to do great work every single day. Consistently named among the top 100 Best Places to Work in Maryland, our team members have the opportunity to grow professionally in a supportive and stimulating environment.

Job Description

General Summary:
Under general supervision, responsible for processing the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. Responsible for triaging routine financial clearance work.

Principal Responsibilities And Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals.
• Initiates and tracks referrals, insurance verification and authorizations for all encounters.
• Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles.
• Works directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier.
• Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status.
• Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements.
• Reviews and follows up on pending authorization requests.
• Coordinates and schedules services with providers and clinics.
• Researches delays in service and discrepancies of orders.
• Assists management with denial issues by providing supporting data.
• Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing.
• Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services.
• Assists Medicare patients with the Lifetime Reserve process where applicable.
• Reviews previous day admissions to ensure payer notification upon observation or admission.
• Must be willing to travel between facilities as needed (applies to specific UMMS Facilities).
• Performs other duties as assigned.

Qualifications

Education and Experience

• High School Diploma or equivalent is required.
• Minimum 2 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.

Knowledge, Skills And Abilities

• Knowledge of medical and insurance terminology.
• Knowledge of medical insurance plans, especially manage care plans.
• Ability to understand, interpret, evaluate, and resolve basic customer service issues.
• Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.
• Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues.
• Basic working knowledge of UB04 and Explanation of Benefits (EOB).
• Some knowledge of medical terminology and CPT/ICD-10 coding.
• Demonstrate dependability, critical thinking, and creativity and problem-solving abilities.
• Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred.
• Knowledge of the Patient Access and hospital billing operations of Epic preferred.

Additional Information
All your information will be kept confidential according to EEO guidelines.

Compensation:
Pay Range: $18.57-$25.99
Other Compensation (if applicable):
Review the 2024-2025 UMMS Benefits Guide.

Seniority level: Not Applicable

Employment type: Full-time

Job function: Other

Industries: Hospitals and Health Care