Financial Clearance Specialist, Entry Level

Summary

Join University of Maryland Charles Regional Medical Center (UM CRMC) as a remote Patient Access Representative! This role focuses on processing patient, insurance, and financial clearance for appointments. You will handle insurance verification, pre-certification, prior authorizations, and scheduling. The position requires a high school diploma and at least two years of relevant healthcare experience. Strong communication and analytical skills are essential. While primarily remote, occasional onsite work may be required. Competitive pay and a comprehensive benefits package are offered, as detailed in the 2024-2025 UMMS Benefits Guide.

Requirements

• Have a High School Diploma or equivalent
• Have a minimum of 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience
• Have knowledge of medical and insurance terminology
• Have knowledge of medical insurance plans, especially manage care plans
• Have the ability to understand, interpret, evaluate, and resolve basic customer service issues
• Possess excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies
• Possess intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues
• Have basic working knowledge of UB04 and Explanation of Benefits (EOB)
• Have some knowledge of medical terminology and CPT/ICD-10 coding
• Demonstrate dependability, critical thinking, and creativity and problem-solving abilities

Responsibilities

• Process administrative and financial components of financial clearance including validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals
• Initiate and track referrals, insurance verification and authorizations for all encounters
• Utilize third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles
• Work directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier
• Input information online or call carrier to submit request for authorization; provide clinical back up for test and documents approval or pending status
• Identify issues and problems with referral/insurance verification processes; analyze current processes and recommend solutions and improvements
• 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
• Pre-register patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing
• Develop and maintain a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services
• Assist Medicare patients with the Lifetime Reserve process where applicable
• Review previous day admissions to ensure payer notification upon observation or admission
• Be willing to travel between facilities as needed (applies to specific UMMS Facilities)
• Perform other duties as assigned

Preferred Qualifications

• Have experience in healthcare registration, scheduling, insurance referral and authorization processes
• Have knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes
• Have knowledge of the Patient Access and hospital billing operations of Epic

Benefits

• Pay Range: $18.93-$23.72
• Other Compensation (as detailed in the 2024-2025 UMMS Benefits Guide)