Starting Range: 

Employment Status: Full Time, 35 hours

SUMMARY OF DUTIES

The Financial Clearance Specialist plays a vital role in the Revenue Cycle team by ensuring that all clients are financially cleared to receive services. This includes verifying insurance eligibility, securing authorizations, communicating with clients about their financial responsibilities, and mitigating financial risks to the organization. The position supports the organization by optimizing revenue cycle operations, minimizing claim denials, improving cash flow, and fostering an exceptional client experience.

POSITION RESPONSIBILITIES

Insurance Verification & Eligibility:

• Verify client insurance coverage and eligibility for services and obtain detailed benefit information including co-pays, deductibles, and authorization requirements using payer portals and technology solutions prior to scheduled appointments.
• Update client records with verified insurance, copay, and deductible information in the organization's electronic health record (EHR) and revenue cycle system(s).

Authorization Management:

• Identify services requiring prior authorization and obtain necessary approvals from insurance payers in a timely manner.
• Communicate with clinical staff, as necessary, to gather and submit required documentation for prior authorizations.
• Monitor and manage pending and ongoing authorizations to ensure proper service coverage and maintain client service continuity.

Client Financial Services:

• Explain insurance benefits, financial responsibilities, and out-of-pocket costs to clients prior to their appointments.
• Provide exceptional service by thoroughly explaining insurance, benefits, and financial responsibilities to clients and families.

Communication, Compliance, and Other Duties:

• Coordinate with scheduling, registration, billing, and programs/services teams to ensure all financial clearance requirements are met.
• Regularly review and update knowledge of insurance policies, regulations, and requirements.
• Maintain accurate and detailed documentation and records of financial clearance activities in the designated health record and revenue cycle system(s).
• Work closely with the Revenue Cycle team to identify opportunities for improvements in process efficiency and effectiveness.
• Completes all trainings required by the agency.
• Performs all other duties as assigned.

QUALIFICATIONS

• Minimum of two years' medical office, billing, insurance verification, or revenue cycle experience required.
• Excellent communication & problem-solving skills.
• Ability to multi-task and work in a fast-paced environment.
• Detailed oriented and organized.
• Proficient with basic computer systems, technology, and software applications such as the Microsoft Office Suite (Outlook, Word, and Excel).

Some things you can look forward to:

• Welcoming, team environment, that inspires you to thrive and be your BestSelf!
• Rewarding work experience!
• Generous paid time off
• Flexible schedule
• Various student loan forgiveness programs
• Multiple and diverse health insurance options
• Many other unique lifestyle & personal insurance options
• Tuition reimbursement
• CASAC certification tuition support
• Professional license/certification renewal reimbursement
• Defensive driving course reimbursement (if required for position)
• Career growth and advancement opportunities
• We look forward to telling you more!