Precertification & Financial Clearance Specialist

cwi; West Allis (WI); On-site; USD 42,000 - 62,000; Full time

Job summary

Children's Wisconsin is seeking a Financial Verification Representative to initiate precertification and authorization for inpatient and outpatient services. You will verify insurance, obtain referrals, and ensure accurate registration information to keep accounts flowing through the billing cycle.

You will work with families, providers, and payers to resolve denials, educate patients about costs, and support financial counseling when needed.

Qualifications

• 2+ years of experience in registration, scheduling or administrative support in a healthcare setting or a business environment.
• 1+ years experience as a Financial Verification Rep preferred.
• Experience with insurance referral and authorization processing required in lieu of Verification Rep experience.
• Epic experience preferred.
• Prior experience working in Windows environment preferred.

Responsibilities

• Initiates precertification and authorizations online, phone or written documentation for all day surgeries, radiology procedures, therapies, psychiatry services, and other outpatient services.
• Contacts insurance companies, primary care physicians, and patient families to secure referrals for patients with out-of-network insurances.
• Enters referral and precertification/prior authorization information into Epic timely and accurately.
• Educates patient/guardian about the managed care process and obtaining valid referrals and authorizations.
• Participates in quality improvement initiatives and department meetings.

Skills

Organizational skills

Analytical skills

Prioritization

Communication skills

HIPAA knowledge

Education

High School diploma or GED/HSED

Tools

Epic

Job description

Children's Wisconsin is seeking a Financial Verification Representative to initiate precertification and authorization for inpatient and outpatient services. You will verify insurance, obtain referrals, and ensure accurate registration information to keep accounts flowing through the billing cycle.

You will work with families, providers, and payers to resolve denials, educate patients about costs, and support financial counseling when needed.