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 add-ons. Financial Clearance Specialists 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. 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 government regulatory forms accurately with the patient or patientâs representative. Specialists must maintain compliance with government regulations (i.e. EMTALA and HIPAA) as it pertains to the insurance process. Representatives 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 II must have the ability to submit/review authorizations for lab, diagnostic, and hospital ambulatory services. Must be able to verify insurance and intermediate knowledge of CPT and ICD codes and medical terminology. Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
Full Time 8 Hour Days (9:00 am - 5:30 pm)Minimum Education:HS Diploma or GED Required.Minimum Experience/Knowledge:Minimum two (2) years of experience in a hospital environment with authorization and insurance verification responsibilities.Knowledge of business office procedures.Knowledge of medical terminology and coding.Knowledge of grammar, spelling, and punctuation to type patient information.Ability to read, understand, 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:AB508 Certification. If no card upon hire, one must be obtained within 30 days of hire or transfer into the department, and maintained by renewal before expiration date.As part of Keck Medicine of USC, USC Verdugo Hills Hospital is the only community hospital in the Foothills area of Los Angeles backed by an academic medical center. With its 40-year legacy of personalized care from expert physicians, experience nurses and a dedicated staff the community has come to know and trust, USCâVHH brings patients the latest medical advancements and 24/7 emergency services. Join this world-class team providing highly-specialized care, up-to-the-minute research and innovative clinical trials.
USC’s Viterbi School of Engineering has been one of the economic engines in Southern California and a vital hub in the California economy. The technical innovations and ideas generated by the Viterbi faculty and research community have resulted in countless innovations, many becoming the foundations for new companies, products and services. The thousands of students graduating each year bring new ideas and vitality to companies in California and beyond. With an annual research budget exceeding $205M each year, more than 46 research centers and institutes, more than 180 faculty members, 7,800 students and over 60,000 impassioned alumni world-wide, the Viterbi School is addressing some of the world’s great challenges.