FINANCIAL CLEARANCE SPECIALIST

Financial Clearance Team Member

The Financial Clearance team is responsible for managing all pre-appointment insurance processes including benefits verification, cost estimates, and prior authorizations.

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
• Medical Assistant Certification preferred

Requirements:

• 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.