Surgery Financial Clearance & Benefits Coordinator

StrideCare; United States; Hybrid; USD 42,000 - 65,000; Full time

Benefits offered by this job

Equal Opportunity Employer

Job summary

StrideCare is seeking a Financial Clearance professional to manage pre-appointment insurance processes, verify benefits in Athena, and initiate authorizations. You will create cost estimates and coordinate with patients and clinics throughout the authorization lifecycle.

The role requires strong communication, detail orientation, and a collaborative approach to ensure timely approvals and accurate documentation while maintaining HIPAA compliance.

Qualifications

• Positive and professional demeanor.
• Strong conflict resolution and problem-solving skills.
• Collaborative team player focused on achieving optimal outcomes.
• Excellent verbal and written communication skills across multiple channels.
• Thorough understanding of insurance coverage and policy requirements.
• Self-motivated with the ability to work independently.
• Flexible and adaptable; able to multitask effectively in a fast-paced environment.
• Perform well under pressure and manages time efficiently.
• High attention to detail and accuracy.
• Reliable and dependable work ethic.
• Open to feedback and demonstrates growth from constructive input.

Responsibilities

• Verify insurance benefits for all patients and accurately document details in Athena.
• Understand insurance criteria and requirements for various treatments.
• Review clinical records to confirm that criteria are met for authorization.
• Initiate pre-authorization or predetermination requests with insurance companies, submitting all necessary clinical documentation via fax or portal.
• Monitor the status of surgical reviews according to established protocols.
• Document authorization request determinations following protocol.
• Manage patient cases throughout the insurance review and authorization process.
• Communicate any adverse determinations to the clinic staff promptly.
• Create cost estimates for procedures, including both insurance-approved treatments and self-pay.
• Maintain a log of surgical procedures ordered and those under insurance review.
• Process incoming and outgoing faxes related to insurance authorizations.
• Handle incoming and outgoing calls with patients and insurance representatives regarding surgical authorizations.
• Contact patients to schedule procedures, review cost estimates, and provide pre/post-operative instructions for specific surgical procedures.
• Communicate with the clinical team regarding questions on benefits, estimates, or authorizations.
• Provide support and training assistance to team members when needed.

Skills

Positive demeanor

Conflict resolution

Team player

Verbal and written communication

Insurance knowledge

Independent work

Multitasking

Attention to detail

HIPAA compliance

Microsoft Office

Education

High School Diploma or GED

Medical Assistant Certification

Tools

MS Office

Job description

StrideCare is seeking a Financial Clearance professional to manage pre-appointment insurance processes, verify benefits in Athena, and initiate authorizations. You will create cost estimates and coordinate with patients and clinics throughout the authorization lifecycle.

The role requires strong communication, detail orientation, and a collaborative approach to ensure timely approvals and accurate documentation while maintaining HIPAA compliance.