Financial Clearance Specialist III - Admitting - Full Time 8 Hour Variable Shift (Non Union)

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. Communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative. Maintain compliance with HIPAA regulations as it pertains to the insurance processes. Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry. Responsible in submitting authorizations for surgery, GI , Imaging chemotherapy, Infusions, invasive and non-invasive procedures, transplants, and all other services as required.
Qualifications

• Req High school or equivalent Or GED required.
• Req 2 years Admitting/ insurance verification experience in a hospital, health plan or Physician office environment.
• Req Broad experience in financial counseling and co-pay collections.
• Req Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non- invasive procedures is highly desirable.
• Req The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting.
• Req Ability to interrupt patient’s insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers.
• Req Strong problem solving customer skills.
• Req Knowledge of business office procedures.
• Req Knowledge of medical terminology and coding.
• Req Knowledge of grammar, spelling, and punctuation to type patient information.
• Req Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.
• Req Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.
• Req Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.
• Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.
• Req Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.

USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying.

As part of Keck Medicine of USC, USC Verdugo Hills Hospital is the only community hospital in the Foothills area of Los Angeles backed by an academic medical center. With its 40-year legacy of personalized care from expert physicians, experienced nurses and a dedicated staff the community has come to know and trust, USC–VHH brings patients the latest medical advancements and 24/7 emergency services. Join this world-class team providing highly-specialized care, up-to-the-minute research and innovative clinical trials.

The hourly rate range for this position is $25.00 - $32.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the p