Financial Clearance Specialist III - Revenue Cycle

RCM Financial Clearance Specialist III

What we do here changes the world. UTHealth Houston is Texas' resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That's where you come in.

Once you join us you won't want to leave. It's because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you'd expect from a top healthcare organization (benefits, insurance, etc.), plus:

• 100% paid medical premiums for our full-time employees
• Generous time off (holidays, preventative leave day, both vacation and sick time all of which equates to around 37-38 days per year)
• The longer you stay, the more vacation you'll accrue!
• Longevity Pay (Monthly payments after two years of service)
• Build your future with our awesome retirement/pension plan!

We take care of our employees! As a world-renowned institution, our employees' wellbeing is important to us. We offer work/life services such as...

• Free financial and legal counseling
• Free mental health counseling services
• Gym membership discounts and access to wellness programs
• Other employee discounts including entertainment, car rentals, cell phones, etc.
• Resources for child and elder care
• Plus many more!

Position Summary:

The RCM Financial Clearance Specialist III position is a key leader within the Revenue Cycle team, responsible for advanced-level insurance verification and authorization functions. This role ensures timely and accurate financial clearance of patient services by securing insurance benefits, prior authorizations, and referrals. The Senior Specialist demonstrates strong analytical ability to resolve complex authorization issues, identify trends, and support process improvements. Additionally, this position acts as a resource and trainer for junior team members, contributing to departmental performance and compliance.

Position Key Accountabilities:

• Oversee comprehensive verification of insurance and benefit coverage, including accurate entry of patient demographics and insurance details, inclusive of charge review functions. Secure and document prior authorizations and referrals based on clinical documentation and payer guidelines. Evaluate insurance policies for medical necessity and initiate Peer-to-Peer (P2P) reviews or appeals for escalated or denied cases.
• Ensure precise documentation of insurance data within Epic, including plan selection validation using the UT Payor Tool. Monitor and report trends in denials, payer issues, and workflow gaps. Consistently meet or exceed quality, productivity, and turnaround benchmarks as set by leadership.
• Effectively communicate with patients regarding insurance coverage, authorization status, and financial responsibility. Provide timely and accurate cost estimates. Collaborate with clinical, scheduling, and patient access teams to ensure coordinated and efficient service delivery.
• Provide guidance and training to junior team members on best practices in insurance verification, payer communications, and Epic documentation standards. Serve as a resource and role model within the team to promote continuous learning and operational consistency.
• Maintain strict compliance with HOOP policies, HIPAA regulations, and payer-specific requirements. Ensure all actions and documentation meet institutional, legal, and accreditation standards.
• Performs other duties as assigned.

Certification/Skills:

• None

Minimum Education:

High School Diploma or equivalent required Associate's Degree in healthcare, business, or related field preferred.

Minimum Experience:

5 years of experience in insurance authorization, verification, or healthcare financial clearance preferred. Proven experience resolving complex insurance cases and mentoring or training staff required

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This position is a security-sensitive position pursuant to Texas Education Code 51.215 and Texas Government Code 411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code 117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R. 791.4.

Residency Requirement:

Employees must permanently reside and work in the State of Texas.