Remote Financial Clearance Specialist, Entry Level

Summary

Join our team at University of Maryland Charles Regional Medical Center as a Financial Clearance Specialist, working remotely with occasional onsite requirements. Process patient and insurance clearance aspects for scheduled and non-scheduled appointments, including validation of insurance and benefits, pre-certification, prior authorizations, and scheduling/pre-registration.

Responsibilities

• Processes 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
• Initiates and tracks referrals, insurance verification and authorizations for all encounters
• Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles
• Works directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier
• Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status
• Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements
• Reviews and follows up on pending authorization requests
• Coordinates and schedules services with providers and clinics
• Researches delays in service and discrepancies of orders
• Assists management with denial issues by providing supporting data
• Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing
• Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services
• Assists Medicare patients with the Lifetime Reserve process where applicable
• Reviews previous day admissions to ensure payer notification upon observation or admission
• Must be willing to travel between facilities as needed (applies to specific UMMS Facilities)
• Performs other duties as assigned