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University of Maryland Medical System · 3 months ago

Financial Clearance Specialist, Surgical Associates

Bel Air, MD

Full-time

Onsite

Entry Level

$18.17/hr - $23.05/hr

2+ years exp

University of Maryland Medical System is a community-based, integrated health system dedicated to providing high-quality care to the residents of northeastern Maryland. The Financial Clearance Specialist is responsible for processing patient, insurance, and financial clearance aspects for appointments, including validation of insurance, pre-certification, and scheduling. This role also involves coordinating services, tracking referrals, and assisting with patient registration and financial assistance.

Hospital & Health Care

No H1B

Security Clearance Required

Responsibilities

Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals

Initiates and tracks referrals, insurance verification and authorizations for all encounters

Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles

Works directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier

Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status

Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements

Reviews and follows up on pending authorization requests

Coordinates and schedules services with providers and clinics

Researches delays in service and discrepancies of orders

Assists management with denial issues by providing supporting data

Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing

Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services

Assists Medicare patients with the Lifetime Reserve process where applicable

Reviews previous day admissions to ensure payer notification upon observation or admission

Must be willing to travel between facilities as needed (applies to specific UMMS Facilities)

Performs other duties as assigned

Qualification

Healthcare revenue cycleInsurance verificationPre-certification processesMedical terminologyEpic softwareVerbal communicationInterpersonal skillsCritical thinking

Required

High School Diploma or equivalent is required

Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience

Knowledge of medical and insurance terminology

Knowledge of medical insurance plans, especially manage care plans

Ability to understand, interpret, evaluate, and resolve basic customer service issues

Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies

Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues

Basic working knowledge of UB04 and Explanation of Benefits (EOB)

Some knowledge of medical terminology and CPT/ICD-10 coding

Demonstrate dependability, critical thinking, and creativity and problem-solving abilities

Preferred

Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred

Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred

Knowledge of the Patient Access and hospital billing operations of Epic preferred

Company

University of Maryland Medical System

Glassdoor3.4

The University of Maryland Medical System (UMMS) was created in 1984 when the state-owned University Hospital became a private, nonprofit organization.

Founded in 1984

Baltimore, MD, US

10001+ employees