Financial Clearance & Authorizations Specialist

Financial Clearance & Authorizations Specialist

Seeking a Transplant Financial Coordinator to support the Heart Transplant Financial Services team. This position is responsible for obtaining financial clearance for transplant patients through insurance verification, benefit investigation, authorization processing, and financial counseling. The coordinator serves as a key liaison between patients, insurance carriers, physicians, clinical staff, and transplant teams to ensure timely approvals and uninterrupted patient care.

The ideal candidate will possess strong healthcare insurance knowledge, authorization experience, excellent communication skills, and the ability to navigate complex payer requirements within a hospital or transplant environment.

Key Responsibilities

• Insurance Verification & Authorization
• Verify patient insurance eligibility, benefits, and coverage for transplant-related services.
• Obtain pre-authorizations, referrals, and financial approvals from commercial, Medicare, Medicaid, and managed care payers.
• Review insurance contracts and payer guidelines to ensure compliance with coverage requirements.
• Track authorization status and proactively resolve pending or denied requests.

Financial Clearance

• Coordinate financial clearance activities for transplant patients prior to treatment.
• Analyze insurance benefits and determine patient financial responsibility.
• Educate patients regarding insurance coverage, co-pays, deductibles, out-of-pocket costs, and financial assistance options.
• Identify coverage gaps and assist patients with securing appropriate financial resources.

Claims & Denial Resolution

• Investigate insurance denials and authorization issues.
• Submit appeals and supporting documentation to insurance carriers.
• Work closely with payers to expedite approvals and resolve reimbursement concerns.
• Maintain accurate records of authorization and denial management activities.

Patient & Team Collaboration

• Serve as a financial resource for transplant coordinators, physicians, nursing staff, and patients.
• Communicate financial requirements and authorization status updates.
• Participate in multidisciplinary transplant team meetings as needed.
• Provide exceptional customer service while maintaining patient confidentiality.

Documentation & Compliance

• Maintain accurate patient records within EMR and financial systems.
• Ensure compliance with HIPAA, Medicare, Medicaid, and payer regulations.
• Support audits and quality improvement initiatives.
• Perform data entry and reporting functions accurately and timely.

Required Qualifications

• High School Diploma or GED required.
• Associate Degree preferred.
• 2+ years of healthcare financial, insurance verification, authorization, patient access, revenue cycle, or transplant financial experience.
• Experience working within hospitals, healthcare systems, transplant centers, specialty clinics, or physician groups.
• Knowledge of: insurance verification, prior authorizations, benefits investigation, medical necessity reviews, claims and appeals processing, Medicare, Medicaid, HMO, PPO, and Managed Care plans.
• Strong computer skills and data entry accuracy.
• Excellent communication and customer service skills.

Preferred Qualifications

• Transplant Financial Coordinator experience.
• Heart Transplant experience.
• Revenue Cycle experience.
• EPIC EMR experience.
• Bilingual English/Spanish.
• Financial counseling experience.
• Patient Access or Financial Clearance experience.