Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days

Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union) Los Angeles, CA The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete within the time allowed by the insurance companies to prevent denials or penalties. The role involves documenting accurate insurance information and authorization details to optimize reimbursement from both payer and patient. Strong working knowledge of insurance plans, contract requirements, and resources is required to facilitate appropriate insurance verification and authorization. Duties include running eligibility checks, securing full benefit coverage information (including COBRA when applicable), confirming demographic information, ensuring coordination of benefit (COB) and insurance plan codes are accurate, verifying coverage for inpatient and outpatient accounts (same day and next‑day add‑ons), determining pre‑certification or pre‑authorization needs, communicating with providers and team regarding out‑of‑network issues, assessing contracted and non‑contracted payer issues, documenting outcomes, collecting patient liability prior to service, conducting all transactions consistently, completing Medicare Secondary Questionnaire, and maintaining HIPAA compliance. The specialist attends workshops, in‑services, and webinars to stay updated on insurance rules and industry changes and submits authorizations for a wide range of medical services. Essential Duties Obtain insurance information/verification/authorization to ensure financial clearance of patient accounts, update registration systems, and ensure insurance plans are properly selected in all scheduling systems. (20%) Calculate patient’s liability by performing mathematical calculations for out‑of‑pocket, co‑insurance, and deductible amounts for all surgery, GI, chemo/infusions, and imaging procedures following documentation standards. (20%) Contact physician offices when services are denied, redirected, or when a peer‑to‑peer review is required, and communicate with physicians regarding admissions, special procedures, outpatient referrals, and same‑day surgeries. (20%) Submit authorizations for surgery, GI, chemo/infusions, and imaging procedures via the Valor software tool or websites, following protocol, and clear assigned worklists in information systems. (15%) Document all authorization information in appropriate registration fields, submit pre‑certification documentation with correct CPT and ICD coding, research payer medical policy requirements, and follow up on routine requests within 3‑5 business days. Scan authorizations into systems and document outcomes. (15%) Perform all other duties as assigned. (10%) Required Qualifications High school diploma or equivalent (GED) required. Two years of admitting/insurance verification experience in a hospital, health plan, or physician office environment. Broad experience in financial counseling and co‑pay collections. Ability to submit authorizations and articulate full insurance benefits for surgery, GI, imaging, chemo, infusions, and invasive/non‑invasive procedures. Extended mathematical calculation ability, extensive experience in hospital and medical business office settings. Strong problem‑solving, customer service, and communication skills. Knowledge of business office procedures, medical terminology, coding, grammar, spelling, and punctuation. Advanced knowledge of CPT codes and medical terminology for insurance verification. Understanding of patient liability and benefits for HMOs and all payer types. Ability to read and follow oral and written instructions, and maintain effective relationships with patients, employees, and the public. Excellent time management, organizational, research/analytical, negotiation, communication, and interpersonal skills. Capable of reading the policy and procedure manual and applying its information to job duties. Required Licenses/Certifications Fire Life Safety Training (LA City). If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before the expiration date. The hourly rate range for this position is $25.00 - $39.69. #J-18808-Ljbffr Keck Medicine of USC