Job Requirements
Coordinates patient, insurance, and financial clearance activities for both scheduled and non‑scheduled appointments, including validation of insurance coverage and benefits; routine and complex pre‑certifications and prior authorizations; and scheduling and pre‑registration. Triages complex financial clearance work.
Primary Responsibilities
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.
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Coordinates administrative and financial components of financial clearance, including validation of insurance coverage and benefits, medical necessity validation, routine and complex pre‑certification and prior authorization, scheduling and pre‑registration, patient benefit and cost estimates, pre‑collection of out‑of‑pocket cost share, and financial assistance referrals.
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Manages service line and/or complex multi‑payer insurance verification, benefit eligibility validation, and prior authorizations, including obtaining and completing required documentation for pre‑certification and referral/authorization processes.
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Performs root‑cause analysis related to no‑authorization denials.
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Cross‑trains and provides guidance to the financial clearance specialist team in day‑to‑day operations.
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Maintains regular communication and follow‑up with patients and families to keep them informed of financial clearance status and self‑pay responsibilities.
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Maintains regular communication and follow‑up with program and department contacts regarding pending insurance, coverage determinations, and other payment‑related matters.
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Develops denial mitigation strategies in collaboration with staff in registration, patient financial services, and clinical areas, as applicable.
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Perform all other duties as assigned.
Work Experience
- Associate’s degree is required. Two (2) years of relevant work experience may substitute for required education.
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Four (4) years of experience in healthcare revenue cycle operations, medical office settings, hospital environments, patient access, or related healthcare experience.
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Previous experience in healthcare registration, insurance referral and authorization processes, patient access, and hospital billing operations within the Epic system.
