Financial Clearance Specialist

Responsibilities Responsible for all pre-service accounts' financial clearance and collection prior to service date. Obtains and verifies accurate insurance information, benefit validation, authorization, and pre-service collections. Initiates billing process and initiates the patient experience for services provided by the hospital. Manages complex, high-dollar services such as surgical, observation, and inpatient services across outpatient verification, elective short procedure/inpatient verification, and urgent admission verification or scheduling. Performs insurance eligibility/benefit verification using EDI transactions, payer web access, and calling payers directly; documents all information within the EMR system. Determines need for appropriate service authorizations (pre-certifications, third‑party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel as necessary. Informs patient/guarantor of liabilities and collects patient liabilities—including co‑payments, co‑insurances, deductibles, deposits, and outstanding balances—at the point of pre‑registration. Requirements High School Diploma or equivalent. Two (2) to Five (5) years of experience in scheduling, financial clearance, or patient access. National certification in HFMA CRCR required within one (1) year of hire. Proficiency in the use of Patient Registration/Patient Accounting systems and related software systems. Associate's degree is preferred. Comprehensive knowledge of scheduling with mastery in at least three (3) modalities and insurance verification processes with three (3) years of scheduling experience in an acute care setting. Strong knowledge of third‑party and government payer billing and reimbursement guidelines as well as department performance standards, policies, and procedures. Hard Skills Insurance Eligibility Verification Benefit Validation Pre‑Service Collections Service Authorizations Patient Liability Collection EDI Transactions EMR Documentation Scheduling Mastery Payer Web Access Third‑Party Billing Guidelines Soft Skills Communication Skills Interpersonal Skills Attention to Detail Problem‑Solving Skills Customer Service Orientation Certifications & Qualifications HFMA CRCR Certification #J-18808-Ljbffr