Financial Clearance Specialist- REMOTE

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.

Exemption Status:

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

Union:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

The role of the Financial Clearance Specialist is to perform a variety of complex duties utilizing insurance and payor knowledge to generate and/or obtain the required insurance referrals and/or authorizations for urgent/emergent inpatient visits, scheduled outpatient procedures and testing prior to services being rendered and/or the release of a claim to the insurance company.

Major Responsibilities:

• Verifies insurance eligibility and coverage utilizing available technologies, payor websites, or by phone contact with third party payors.
• Performs updates and corrections to patient demographic and insurance information.
• Resolves claim edits and stop bills.
• Notifies insurance carriers of all inpatient admissions following payer guidelines.
• Follows up on all surgeries, inpatient and NICU admissions until final authorization is secured.
• Collects and processes patient phone payments.
• Generates authorizations and/or insurance referrals for outpatient testing, treatment and procedures following payor guidelines
• Prepares patient estimates for inpatient admissions, outpatient testing and treatment.
• Ability to effectively resolve any PAS denials occurring because of an insurance referral, authorization, or eligibility error.
• Ability to write clear concise appeals to payers to overturn payment denials.
• Escalates payer issues to management as they are identified.

The duties and responsibilities stated are a general summary and not all inclusive.

Position Qualifications:

License/Certification/Education:

Required:

• High school diploma.

Preferred:

• Associates Degree in business or healthcare-related field.

Experience/Skills:

Required:

• English speaking, reading and writing skills.
• Strong intrapersonal and communication skills.

Preferred:

• Previous authorization, insurance referral, and telephone customer service experience.
• Previous experience in a health care organization.
• Bilingual speaking, reading, and writing skills.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.