Financial Clearance Specialist

Job Requirements

At the University of Maryland Medical System (UMMS), we are committed to providing exceptional patient care and creating a seamless healthcare experience. We are seeking a detail-oriented and customer-focused Financial Clearance Specialist to join our Patient Access team.

Under general supervision, the Financial Clearance Specialist is responsible for processing the patient, insurance, and financial clearance aspects of both scheduled and unscheduled services. This role ensures patients are financially cleared prior to services through insurance verification, benefits validation, authorization management, scheduling support, and patient financial counseling. The specialist serves as a critical link between patients, providers, insurance carriers, and internal departments to facilitate timely access to care while supporting revenue cycle performance.

Key Responsibilities:

• Verify insurance eligibility, benefits, referrals, and authorization requirements to ensure patients are financially cleared prior to receiving services.
• Obtain, submit, and monitor routine and complex pre-certifications, prior authorizations, and referrals while maintaining accurate documentation.
• Provide patients with benefit information, cost estimates, and financial assistance resources, including collection of applicable patient responsibility amounts.
• Coordinate with physicians, clinical staff, insurance carriers, and ancillary departments to support timely access to care and resolve authorization or scheduling issues.
• Complete patient pre-registration activities, maintain payer notifications, assist with denial prevention efforts, and identify opportunities to improve financial clearance processes.

Work Experience

Education and Experience:

• High School Diploma or equivalent is required.
• Minimum two years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.
• Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred.

Knowledge, Skills and Abilities:

• Knowledge of medical and insurance terminology.
• Basic working knowledge of UB04 and Explanation of Benefits (EOB).
• Some knowledge of medical terminology and CPT/ICD-10 coding.
• Knowledge of the Patient Access and hospital billing operations of Epic preferred.