Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days Non-Exempt Non-Union

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility benefit verification and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans contract requirements and resources to facilitate appropriate insurance verification and authorization. Must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers confirm all demographic information is correct and ensure coordination of benefit (COB) and insurance plan codes are accurate. Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day addons. Determine if precertification preauthorization or a referral is required for insurance companies and obtain if applicable. Communicate with providers and team regarding outofnetwork issues assess contracted and noncontracted payer issues and document outcomes and next steps. Determine communicate and collect patient liability prior to service and attempt to collect prior balances. Conduct all transactions appropriately and consistently and complete Medicare Secondary Questionnaire accurately with the patient or patients representative. Maintain compliance with HIPAA regulations as it pertains to the insurance processes. Maintain professional development by attending workshops inservices and webinars to remain uptodate on insurance rules and regulations in addition to changes within the industry. Responsible in submitting authorizations for surgery GI Imaging chemotherapy Infusions invasive and noninvasive procedures transplants and all other services as required.

Essential Duties:

• Responsible for obtaining insurance information/verification/authorization to ensure financial clearance of patient accounts. Updates both professional and / or hospital registration systems. Ensure all insurance plans are properly selected in all registration and scheduling information systems. Responsible for calling insurance or use Internet portals to obtain and document: a) Insurance eligibility and benefits b) Financial responsibility c) Authorization and / or PreCertification as required. 20
• Responsible for understanding and articulating patients liability by performing mathematical calculations in understanding out of pocket coinsurance and deductible calculations. Responsible for full calculations on all Surgery GI Chemo/Infusions Imaging on non and invasive procedures by following the appropriate documentation standard guidelines. 20
• Responsible for contacting Physician office when a patients services are denied redirected and or when a Peer to Peer is required. Communicate with physician offices regarding proposed admissions special procedures outpatient referrals and same day surgeries. 20
• Responsible for submitting authorizations for Surgery GI Chemo/Infusions Imaging on non and invasive procedures. Submits authorizations via the Valor software tool and or websites and follows the appropriate protocol when submitting authorizations. Responsible for clearing assigned worklists in any of the information systems 15
• Responsible for completing Documentation of all authorization information is entered in all appropriate registration fields and follows the approved documentation standard guidelines. Submit precertification documentation to third party payers for authorization with correct CPT and ICD coding. Research payer medical policy requirements for treatment authorizations and understand process for submitting precertification requests. Follow up for routine requests from the message center are followed up on 35 business days consistently. Scan all authorizations into appropriate system under the respective patient accounts and document authorization outcomes in the registration system. 15
• Perform all other duties as assigned. 10

Required Qualifications:

• Req High school or equivalent Or GED required.

• Req 2 years Admitting/ insurance verification experience in a hospital health plan or Physician office environment.
• Req Broad experience in financial counseling and copay collections.

• Req Ability to submit authorization and articulate full insurance benefits for Surgery GI Imaging Chemo Therapy Infusions and invasive and non invasive procedures is highly desirable.
• Req The extended ability to perform mathematical calculations extensive experience in hospital and medical business office setting.
• Req Ability to interrupt patients insurance coverage identify services that are not covered benefit and provide clear explanation to patients and providers.
• Req Strong problem solving customer skills.
• Req Knowledge of business office procedures.
• Req Knowledge of medical terminology and coding.
• Req Knowledge of grammar spelling and punctuation to type patient information.
• Req Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.
• Req Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
• Req Ability to read understand and follow oral and written instructions and establish and maintain effective working relationships with patients employees and the public.
• Req Excellent time management organizational skills research/analytical skills negotiation communication (written and verbal) and interpersonal skills.
• Req Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.

Preferred Qualifications:

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin protected veteran status disability or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone ator by email at. Inquiries will be treated as confidential to the extent permitted by law.

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