University Of Southern California Alhambra , CA 91801
Posted 1 week ago
The Financial Clearance Specialist III 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. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. 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. Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. Communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative. Maintain compliance with HIPAA regulations as it pertains to the insurance processes. 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. Responsible in submitting authorizations for surgery, GI , Imaging chemotherapy, Infusions, invasive and non-invasive procedures, transplants, and all other services as required.
Essential Duties:
Required Qualifications:
Req High school or equivalent Or GED required.
Req 2 years Admitting/ insurance verification experience in a hospital, health plan or Physician office environment.
Req Broad experience in financial counseling and co-pay collections.
Req Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non- invasive procedures is highly desirable.
Req The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting.
Req Ability to interrupt patient's insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers.
Req Strong problem solving customer skills.
Req Knowledge of business office procedures.
Req Knowledge of medical terminology and coding.
Req Knowledge of grammar, spelling, and punctuation to type patient information.
Req Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.
Req Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
Req Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.
Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.
Req Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.
Preferred Qualifications:
Required Licenses/Certifications:
The hourly rate range for this position is $22.00 - $34.18. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
USC is an equal opportunity, affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC will consider for employment all qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring ordinance. We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu. Inquiries will be treated as confidential to the extent permitted by law.
Read USC's Clery Act Annual Security Report
Notice on Non-Discrimination
Certain positions are subject to background screening
EEO is the Law
EEO is the Law Supplement
Pay Transparency Non-Discrimination
USC is an E-Verify Employer
If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser:
https://wd5.myworkday.com/usc/d/inst/1$9925/9925$109779.htmld
University Of Southern California