FINANCIAL CLEARANCE SPECIALIST
5 days ago
Addison
Job DescriptionDescription: Job Summary: The Financial Clearance team is responsible for managing all pre-appointment insurance processes including benefits verification, cost estimates, and prior authorizations for multiple specialties in various markets. Supervisory Responsibilities: N/A Essential Duties / Responsibilities: • Verify insurance benefits for all patients and accurately document details in Athena., • Understand insurance criteria and requirements for various treatments., • Review clinical records to confirm that criteria are met for authorization., • Initiate pre-authorization or predetermination requests with insurance companies, submitting all necessary clinical documentation via fax or portal., • Monitor the status of surgical reviews according to established protocols., • Document authorization request determinations following protocol., • Manage patient cases throughout the insurance review and authorization process., • Communicate any adverse determinations to the clinic staff promptly., • Create cost estimates for procedures, including both insurance-approved treatments and self-pay., • Maintain a log of surgical procedures ordered and those under insurance review., • Process incoming and outgoing faxes related to insurance authorizations., • Handle incoming and outgoing calls with patients and insurance representatives regarding surgical authorizations., • Contact patients to schedule procedures, review cost estimates, and provide pre/post-operative instructions for specific surgical procedures., • Communicate with the clinical team regarding questions on benefits, estimates, or authorizations., • Provide support and training assistance to team members when needed. Required Skills / Abilities: • Positive and professional demeanor, • Strong conflict resolution and problem-solving skills, • Collaborative team player focused on achieving optimal outcomes, • Excellent verbal and written communication skills across multiple channels, • Thorough understanding of insurance coverage and policy requirements, • Self-motivated with the ability to work independently, • Flexible and adaptable; able to multitask effectively in a fast-paced environment, • Perform well under pressure and manages time efficiently, • High attention to detail and accuracy, • Reliable and dependable work ethic, • Open to feedback and demonstrates growth from constructive input, • Proficient in Microsoft Office applications, • Maintains strict compliance with HIPAA regulations, • Perform other related duties as assigned. Education and Experience: • High School Diploma or GED required, • Ability to sit for extended periods while working on a computer., • Manual dexterity to operate standard office equipment, including computers, phones, and fax machines., • Ability to occasionally lift and carry items weighing up to 20 pounds., • Sufficient visual acuity to perform tasks involving computer screens and paper documents., • Ability to move throughout the office to access files, equipment, and other necessary resources., • Home office requirements: Maintain a dedicated workspace that is professional, organized, and free from distractions., • Have a reliable high-speed internet connection capable of supporting voice calls, data entry, and system usage without interruption., • Ensure workspace security and confidentiality, adhering to company policies on data protection and HIPAA privacy standards.