Insurance Verification & Patient Financial Clearance Specialist

U.S. Dermatology Partners; Tyler (TX); On-site; USD 45,000 - 65,000; Full time

Job summary

U.S. Dermatology Partners is seeking a Patient Financial Clearance Specialist in Texas to verify insurance eligibility and benefits for scheduled patients.

You will coordinate COB and use NextGen to ensure correct payer assignment and financial class, while guiding patients on expected payments prior to service. Responsibilities include obtaining authorizations, communicating policies, and resolving claim edits.

Qualifications

• 3+ years of medical insurance verification or patient financial clearance experience.
• Experience with PCP referrals and/or prior authorizations preferred.
• Understanding of CMS Conditions for Coverage guidelines.

Responsibilities

• Verify information for accurate verification and eligibility.
• Determine if secondary/tertiary insurance should be added and select the appropriate payer.
• Set up COB in NextGen and coordinate benefits accurately.
• Use Rivet, Availity, and payer portals to obtain eligibility, benefits, and/ or authorizations.
• Enter insurance data into NextGen with correct payer and financial class.
• Notify patients about out-of-network considerations and applicable policies.
• Ensure timely and accurate insurance verifications; document findings and estimated amounts due.
• Contact patients under CMS Conditions for Coverage to review responsibilities before service date.
• Check procedure lists and notify patients if not payable; present Self-Pay options.
• Obtain authorizations/referrals and enter into NextGen; communicate the financial policy.
• Resolve claim edits related to authorizations, demographics and insurance.
• Track and report trend data to manager; support workflow improvements.
• Complete insurance-related tasks and assist with process optimization.
• Adhere to safety policies and support high quality customer service.

Skills

NextGen experience

Availity experience

Rivet experience

Microsoft Excel

Microsoft Word

HIPAA knowledge

Customer service

Coordination of Benefits

Tools

NextGen

Availity

Rivet

Excel

Word

Job description

U.S. Dermatology Partners is seeking a Patient Financial Clearance Specialist in Texas to verify insurance eligibility and benefits for scheduled patients.

You will coordinate COB and use NextGen to ensure correct payer assignment and financial class, while guiding patients on expected payments prior to service. Responsibilities include obtaining authorizations, communicating policies, and resolving claim edits.