DESCRIPTION

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Financial Clearance and Insurance Authorization Specialist I is an experienced revenue cycle professional responsible for financially securing scheduled and unscheduled hospital and professional services by verifying insurance eligibility and benefits coverage, and by securing insurance pre-certification and/or authorization for inpatient and/or outpatient services.

The Specialist communicates the status of coverage/benefits verification and authorization directly with patients and providers, and facilities rescheduling of services as appropriate. The Specialist provides and collects estimated patient liability amounts.

MINIMUM QUALIFICATIONS

• Demonstrated hospital and/or professional services pre-access or billing experience.

• Minimum of three (3) years of hospital and/or professional services pre-access or billing experience in an academic or other complex, multispecialty setting.

• May consider less than three (3) years of experience for candidates with a college degree.

• Solid understanding of principles of excellent customer service, customer communications, and/or problem resolution relevant to healthcare settings.

• Experience must include insurance eligibility and benefits coverage verification, obtaining pre-certification and/or authorization for medical services, and providing explanations and/or estimates of patient financial responsibility.

• Experience with insurance/benefits verification portals or other applications, and experience with Epic or other similar patient registration, scheduling and/or billing information systems.

• Thorough knowledge eligibility, covered benefits, medical necessity and pre-authorization rules for federal, state, and commercial third-party payers.

• Proven knowledge of medical terminology, CPT, ICD-10, HCPCS, NDC, and modifier codes, including impact on benefits eligibility, authorization, and reimbursements for medical services.

• Demonstrated ability to understand and interpret payer contract terms and insurance verification/benefits eligibility responses.

• Strong understanding of deductibles, coinsurance and non-covered benefits, and ability to derive accurate estimate of patient responsibility.

• Excellent ability to communicate effectively, verbally and in writing.

• Proficiency using Microsoft Office applications (including Outlook, Skype/Lync, Excel and Word).

PREFERRED QUALIFICATIONS

• Community college or university courses in medical terminology, medical coding, finance or other relevant subject matter.

• NAHAM Certified Healthcare Access Manager, HFMA Certified Revenue Cycle Representative, and/or Certified Procedural Coder (CPC or CPC-H) certifications.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.