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.

• A minimum of four (4+) or more years of relevant experience.

• Experience with both hospital and professional services pre-certification and authorization experience.

• Prefer experience with benefits verification and authorization initial and additional inpatient hospital days, inpatient and outpatient procedures, outpatient diagnostic services, provider consultations and other visits, prescription drugs, SNF, rehabilitation services, durable medical equipment, and home health.

• Experience working with Epic registration, scheduling and referral applications.

• Completion of organization-sponsored or professional organization training in principles of customer service, customer communications and/or problem resolution relevant to healthcare settings.

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.