Senior Financial Clearance Specialist

April 2

🦀 Maryland – Remote

Although this job is listed in Maryland, this company may be open to hiring remote in other states.

💵 $25 - $27 / hour

⏰ Full Time

🟠 Senior

💸 Financial Planning and Analysis

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Miratech

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Miratech helps visionaries to change the world. We are a global IT services and consulting company that brings together global enterprise innovation and start-up innovation. Today we support digital transformation for the largest enterprises on the planet.

Outsourcing • Software Development • Professional Services

501 - 1000 employees

Founded 1989

💰 Private Equity Round on 2022-04

📋 Description

• General Summary Under limited supervision, responsible for coordinating the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including, validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. • Responsible for triaging complex financial clearance work. • Coordinates 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. • Manages service line, and/or complex multi-payer insurance verification and benefit eligibility validation and prior authorizations, including obtaining and completing documentation for pre-certification and referrals/authorizations. • Performs root cause analysis on no authorization denials. • Cross trains and provides guidance to team of financial clearance specialists in day to day operations • Maintains regular communication and follow-up with patients and families to keep them informed of clearance and self-pay matters. • Maintains regular communication and follow-up with program and department contacts regarding pending insurance, coverage, and other payment-related matters. • Develops denial mitigation strategies with staff in registration, patient financial services, and clinical areas, as applicable. • Must be willing to travel between facilities as needed (applies to specific UMMS Facilities). • Performs other duties as assigned.

🎯 Requirements

• Requires minimum of Associates Degree. • Work experience may substitute degree (i.e. 2 years of experience for 1 year of education). • Minimum 4 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience. • Experience in healthcare registration, insurance referral, authorization processes, patient access and hospital billing operations of EPIC system required. • Knowledge, Skills and Abilities Intermediate proficiency in Microsoft Office. • Excellent verbal, communication, interviewing, and interpersonal skills to interact with peers, superiors, patients, member of healthcare team and external agencies. • Ability to understand, interpret, evaluate, and resolve complex 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. • Knowledgeable of financial clearance functions, can problem solve functional level issues, and is able to provide input from an operational perspective for decision-making. • Advanced analytical skills to resolve complex problems and provide patient and referring physicians with information and assistance with financial clearance issues. • Effectively maintains leadership in group environment and promotes teamwork. • Must be able to work concurrently on a variety of tasks/projects. • Ability to meet customer service, productivity and quality standards. • Must maintain confidential information. • Advanced knowledge of healthcare revenue cycle, reimbursement, medical and insurance terminology. • Advanced knowledge and demonstrated proficiency in government and non-governmental regulations, payer billing and regulations, and manage care plans. • Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes required.

🏖️ Benefits

• Review the 2024-2025 UMMS Benefits Guide