Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Financial Clearance Specialist III Responsible for ensuring insurance eligibility, benefit verification, and authorization processes are completed within the time allowed by insurance companies to prevent denials or penalties. Document accurate insurance information and authorization details to optimize reimbursement from payer and patient. Maintain working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Essential Duties Obtain insurance eligibility, benefits, financial responsibility, and authorization or pre‑certification information via phone or internet portals. Verify insurance coverage for inpatient and outpatient accounts (same day and next day add‑ons); determine if pre‑certification, pre‑authorization, or referral is required and obtain it. Contact providers and physician offices when services are denied, redirected, or when a peer‑to‑peer is needed; communicate proposed admissions, special procedures, outpatient referrals, and same‑day surgeries. Submit authorizations for surgery, GI, imaging, chemotherapy, infusions, and other invasive and non‑invasive procedures using Valor software or approved websites; document entries in registration systems and scan into appropriate system. Calculate patient liability, co‑insurance, deductible amounts, and out‑of‑pocket responsibilities for immediate and future charges. Collect patient liability prior to service and pursue prior balances; conduct Medicare Secondary Questionnaire with patients or representatives. Ensure coordination of benefits (COB), insurance plan codes, and contract compliance for each case; confirm all demographic information is correct. Use contractor’s or employer’s COBRA information when applicable; maintain HIPAA compliance for insurance processes. Research payer medical policy requirements for treatment authorizations and understand pre‑certification submission processes. Follow up routine requests from the message center 3–5 business days; scan all authorizations into the system and document outcomes. Complete documentation of all authorization information in registration fields per approved guidelines; submit pre‑certification documentation with correct CPT and ICD coding. Maintain professional development through workshops, in‑services, and webinars; remain current on insurance rules and industry changes. Perform other duties as assigned. Required Qualifications High school diploma or equivalent (GED) and at least 2 years of admitting/insurance verification experience in a hospital, health plan, or physician office. Strong knowledge of insurance plans, medical terminology, coding (CPT, ICD), medical policies, and contracting. Experience in financial counseling and co‑pay collections; ability to perform complex calculations for patient responsibility. Excellent problem‑solving, customer service, communication (written and verbal), negotiation, interpersonal, time‑management and organizational skills. Proficiency in reading policy documents, procedures manuals, and following instructions; ability to establish effective relationships with patients, employees, and the public. Typing skills with strong grammar, spelling, and punctuation. Ability to interact with providers, insurers, and coordinate benefits accurately. Commitment to HIPAA compliance and confidentiality. Required Licenses / Certifications Fire Life Safety Training (LA City). Card must be obtained within 30 days of hire and renewed before expiration. Salary $25.00–$39.69 per hour. Equal Opportunity Employment USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. #J-18808-Ljbffr University of Southern California