Financial Clearance Specialist, Entry Level

About the position This remote position involves processing patient, insurance, and financial clearance aspects for both scheduled and non-scheduled appointments. The role includes validating insurance and benefits, handling pre-certifications and prior authorizations, and managing scheduling and pre-registration tasks. The position requires effective communication with healthcare providers and patients to ensure smooth financial clearance processes. Responsibilities • Process administrative and financial components of financial clearance including validation of insurance/benefits and medical necessity validation. , • Handle routine and complex pre-certification and prior authorization requests. , • Schedule and pre-register patients, obtaining necessary demographic and insurance information. , • Initiate and track referrals, insurance verification, and authorizations for all encounters. , • Utilize third-party payer websites and real-time eligibility tools to retrieve coverage eligibility and benefit information. , • Work directly with physician's office staff to obtain clinical data needed for authorization. , • Input information online or call carriers to submit requests for authorization and document approval or pending status. , • Identify issues with referral/insurance verification processes and recommend solutions. , • Review and follow up on pending authorization requests. , • Coordinate and schedule services with providers and clinics. , • Research delays in service and discrepancies of orders. , • Assist management with denial issues by providing supporting data. , • Assist Medicare patients with the Lifetime Reserve process where applicable. , • Review previous day admissions to ensure payer notification upon observation or admission. , • Perform other duties as assigned. Requirements • High School Diploma or equivalent is required. , • Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience. , • Knowledge of medical and insurance terminology. , • Knowledge of medical insurance plans, especially managed care plans. , • Ability to understand, interpret, evaluate, and resolve basic customer service issues. , • Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills. , • Intermediate analytical skills to resolve problems and provide 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. Nice-to-haves • Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred. , • 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. Benefits • Opportunity to grow professionally in a supportive and stimulating environment. , • Consistently named among the top 100 Best Places to Work in Maryland. Apply Job!