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Financial Clearance Specialist III
Ref No.: 18-14662
Location: Los Angeles, California
Financial Clearance Specialist III
Los Angeles, CA


Financial Clearance Specialist III must have the ability to submit authorizations for surgery, chemotherapy, transplants, and all other complex services. 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.
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 Medicare Secondary Questionnaire accurately with the patient or patient's representative. Specialists must maintain compliance with HIPAA regulations as it pertains to the insurance processes. 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 III must have the ability to submit authorizations for surgery, chemotherapy, transplants, and all other complex services. 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.
Minimum Education: HS Diploma or GED Required.
Minimum Experience/Knowledge: Minimum five (5) 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, 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: AB 508 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