FINANCIAL CLEARANCE SPECIALIST

Description

Job Summary: The Financial Clearance team is responsible for managing all pre-appointment insurance processes including benefits verification, cost estimates, and prior authorizations.

Supervisory Responsibilities: N/A

Essential Duties / Responsibilities:

• Verify insurance benefits for all patients and accurately document details in Athena.
• Understand insurance criteria and requirements for various treatments.
• Review clinical records to confirm that criteria are met for authorization. 
• Initiate pre-authorization or predetermination requests with insurance companies, submitting all necessary clinical documentation via fax or portal. 
• Monitor the status of surgical reviews according to established protocols. 
• Document authorization request determinations following protocol.  
• Manage patient cases throughout the insurance review and authorization process.
• Communicate any adverse determinations to the clinic staff promptly.
• Create cost estimates for procedures, including both insurance-approved treatments and self-pay.
• Maintain a log of surgical procedures ordered and those under insurance review.
• Process incoming and outgoing faxes related to insurance authorizations.
• Handle incoming and outgoing calls with patients and insurance representatives regarding surgical authorizations.
• Contact patients to schedule procedures, review cost estimates, and provide pre/post-operative instructions for specific surgical procedures.
• Communicate with the clinical team regarding questions on benefits, estimates, or authorizations.
• Provide support and training assistance to team members when needed.

Required Skills / Abilities: 

• Positive and professional demeanor
• Strong conflict resolution and problem-solving skills
• Collaborative team player focused on achieving optimal outcomes
• Excellent verbal and written communication skills across multiple channels
• Thorough understanding of insurance coverage and policy requirements
• Self-motivated with the ability to work independently
• Flexible and adaptable; able to multitask effectively in a fast-paced environment
• Perform well under pressure and manages time efficiently
• High attention to detail and accuracy
• Reliable and dependable work ethic
• Open to feedback and demonstrates growth from constructive input
• Proficient in Microsoft Office applications
• Maintains strict compliance with HIPAA regulations
• Perform other related duties as assigned.

Education and Experience: 

• High School Diploma or GED required
• Medical Assistant Certification preferred

*StrideCare is an Equal Opportunity Employer and is committed to diversity and inclusion in our workforce. We encourage applications from candidates of all backgrounds and experiences.

Requirements

• Ability to sit for extended periods while working on a computer.
• Manual dexterity to operate standard office equipment, including computers, phones, and fax machines.
• Ability to occasionally lift and carry items weighing up to 20 pounds.
• Sufficient visual acuity to perform tasks involving computer screens and paper documents.
• Ability to move throughout the office to access files, equipment, and other necessary resources.
• Home office requirements: Maintain a dedicated workspace that is professional, organized, and free from distractions.
• Have a reliable high-speed internet connection capable of supporting voice calls, data entry, and system usage without interruption.
• Ensure workspace security and confidentiality, adhering to company policies on data protection and HIPAA privacy standards.

Interested in Joining Our Team?

If you are interested in this position, please complete our Culture Index Survey as part of the application process.

Step 1: Complete the Culture Index Survey: Culture Index 

Step 2: Submit your application for this position.