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. Specialist III are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist III 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. Specialist III must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Financial Clearance Specialist III must determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. The individual will be expected to communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps.
Specialist III must also determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Specialist III are to conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patientâs representative. Specialists must maintain compliance with HIPAA regulations as it pertains to the insurance processes. Specialist III must maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry.
Financial Clearance Specialist III is responsible in submitting authorizations for surgery, GI , Imaging chemotherapy, Infusions, invasive and non-invasive procedures, transplants, and all other services as required.
Minimum Education:HS Diploma or GED Required.Minimum Experience/Knowledge:Minimum 2 years of admitting/ insurance verification experience in a hospital, health plan or Physician office environment.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. The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting. Broad experience in financial counseling and co-pay collections. Ability to interrupt patientâs insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers. Strong problem solving customer skills. Knowledge of business office procedures. Knowledge of medical terminology and coding.Knowledge of grammar, spelling, and punctuation to type patient information.Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology. Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills. Capable of working assigned shifts, overtime when approved.Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.Required License/Certification:Fire and Safety Certification. If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date.
USC is the leading private research university in Los Angeles—a global center for arts, technology and international business. With more than 47,500 students, we are located primarily in Los Angeles but also in various US and global satellite locations. As the largest private employer in Los Angeles, responsible for $8 billion annually in economic activity in the region, we offer the opportunity to work in a dynamic and diverse environment, in careers that span a broad spectrum of talents and skills across a variety of academic and professional schools and administrative units. As a USC employee and member of the Trojan Family—the faculty, staff, students, and alumni who make USC a great place to work—you will enjoy excellent benefits, including a variety of well-being programs designed to help individuals achieve work-life balance.