Financial Clearance Specialist I - Pre-Arrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

The Financial Clearance Specialist 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. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans contract requirements and resources to facilitate appropriate insurance verification and authorization. Individuals 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. Specialists must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day addons. Financial Clearance Specialists must determine if precertification preauthorization or a referral is required for insurance companies and obtain if applicable. The individual will be expected to communicate with providers and team regarding outofnetwork issues assess contracted and noncontracted payer issues and document outcomes and next steps. Specialists must also determine communicate and collect patient liability prior to service and attempt to collect prior balances. Representatives are to conduct all transactions appropriately and consistently and complete Medicare Secondary Questionnaire accurately with the patient or patients representative. Specialists must maintain compliance with HIPAA regulations as it pertains to the insurance processes. Representatives must maintain professional development by attending workshops inservices and webinars to remain uptodate on insurance rules and regulations in addition to changes within the industry. Financial Clearance Specialist I is responsible for submitting authorizations for an ambulatory visit. Must be able to verify insurance and basic knowledge of both CPT codes and medical terminology. Must also be able to understand and interpret patient liability and benefits

Essential Duties:

• Responsible for obtaining insurance information/verification/authorization to ensure financial clearance of patient accounts. Updates both professional and / or hospital registration systems.
• Responsible for completing all registration and insurance fields in both professional and / or hospital registration 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.
• Responsible for calculating patient liability on hospital and professional accounts and communicating/collecting the liability from the patient.
• Ensure all insurance plans are properly selected in all registration and scheduling information systems
• Responsible for clearing assigned worklists in any of the information systems.
• Communicate with physician offices regarding proposed admissions special procedures outpatient referrals and same day surgeries.
• Responsible for preparing preregistration on scheduled procedures (i.e. Ancillary Diagnostic Surgeries).
• Contact patients and / or Physician office as needed for additional information.
• Utilize fax applications as appropriate and perform document imaging as required.
• Actively obtain written clinical documentation for authorization submissions from Medical/Nursing staff.
• 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 on outstanding authorization requests and medical documentation requests in a timely manner.
• Communication with medical/clinical staff and patients on authorization status/outcome and / or with Director on denied or disputed claims.
• Scan all authorizations into appropriate system under the respective patient accounts and document authorization outcomes in the registration system.
• Perform all other duties as assigned.

Required Qualifications:

• Req High school or equivalent Or GED required.

• Req 1 year Experience in a hospital environment with authorization and insurance verification responsibilities.

• 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 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. Capable of working assigned shifts overtime when approved.
• 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 at (213)or by email at. Inquiries will be treated as confidential to the extent permitted by law.

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