Insurance Verification & Patient Financial Clearance Expert

U.S. Dermatology Partners; Tyler (TX); On-site; USD 26,000 - 30,000; Full time

Job summary

U.S. Dermatology Partners is seeking a Patient Financial Clearance Specialist in Tyler, TX to verify insurance eligibility for scheduled patients.

You will follow CMS guidelines, coordinate benefits, and input data into NextGen while communicating estimated patient responsibilities. The role requires 3+ years in medical insurance verification and prior authorization workflows, with strong Excel/Word proficiency and ability to work under tight timelines.

Qualifications

• 3+ years of work experience in medical insurance verification and/or patient financial clearance
• 3+ years of work experience in PCP Referral and/or Prior Authorization initiation and follow-up

Responsibilities

• Verify sufficient information for accurate verification and eligibility
• Determine if secondary/tertiary insurance should be added to the patient’s account and proper payer selected
• Coordinate benefits (COB) in NextGen
• Utilize Rivet, Availity, payer portals to obtain eligibility/benefits/referrals
• Enter patient insurance information into NextGen with correct payer and financial class
• Follow policies when accepting out-of-network payers and inform patient
• Document findings in patient account and communicate estimated amounts due
• Contact patient per CMS guidelines before service date to review responsibility
• Check insurer approved procedure lists and notify patient if not payable
• Obtain authorizations/referrals and enter into NextGen
• Communicate USDP’s financial policy to patient when applicable
• Resolve claim edits related to authorizations/demographics/insurance
• Track and report trending data on claim edits to manager
• Assist workflow optimization through new procedures and policies

Skills

Interpersonal skills

Communication skills

Time management

Analytical ability

English proficiency

Tools

NextGen

Availity

Rivet

Payer portals

Job description

U.S. Dermatology Partners is seeking a Patient Financial Clearance Specialist in Tyler, TX to verify insurance eligibility for scheduled patients.

You will follow CMS guidelines, coordinate benefits, and input data into NextGen while communicating estimated patient responsibilities. The role requires 3+ years in medical insurance verification and prior authorization workflows, with strong Excel/Word proficiency and ability to work under tight timelines.