University of Maryland Medical System
Financial Clearance Specialist Surgical Associates
University of Maryland Medical System, Bel Air, Maryland, United States, 21014
Overview
University of Maryland Upper Chesapeake Health (UM UCH) offers residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience. UM UCH is a community-based, integrated, non-profit health system whose vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We provide high quality care to all and work with the community and other health organizations to promote health and education. UM UCH owns and operates several facilities and entities in the region, including UM HMH, UM UCMC, the Upper Chesapeake Health Foundation, the Kaufman Cancer Center, and the Senator Bob Hooper House. Job location details and facility responsibilities will be determined by UMMS facilities as needed. General Summary
Under general supervision, responsible for processing the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. Responsible for triaging routine financial clearance work. Principal Responsibilities And Tasks
The following descriptions outline the general nature and level of work performed by personnel in this classification and are not exhaustive. Process administrative and financial components of financial clearance, including validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share and financial assistance referrals. Initiate and track referrals, insurance verification and authorizations for all encounters. Utilize third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles. Work directly with physician office staff to obtain clinical data needed to acquire authorization from carrier. Input information online or call carrier to submit requests for authorization; provide clinical backup for tests and document approval or pending status. Identify issues and problems with referral/insurance verification processes; analyze current processes and recommend solutions and improvements. Review and follow up on pending authorization requests. Coordinate and schedule services with providers and clinics. Research delays in service and discrepancies of orders. Assist management with denial issues by providing supporting data. Pre-register patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing. Develop and maintain working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services. Assist Medicare patients with the Lifetime Reserve process where applicable. Review previous day admissions to ensure payer notification upon observation or admission. Must be willing to travel between facilities as needed (applies to specific UMMS facilities). Performs other duties as assigned. Qualifications
Education and Experience
High School Diploma or equivalent is required. Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience. Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred. Knowledge, Skills And Abilities
Knowledge of medical and insurance terminology. Knowledge of medical insurance plans, especially managed care plans. Ability to understand, interpret, evaluate, and resolve basic customer service issues. Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies. Intermediate analytical skills to resolve problems and provide patients and referring physicians with information and assistance with financial clearance issues. Basic working knowledge of UB04 and Explanation of Benefits (EOB). Some knowledge of medical terminology and CPT/ICD-10 coding. Demonstrate dependability, critical thinking, and creativity and problem-solving abilities. Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred. Knowledge of the Patient Access and hospital billing operations of Epic preferred. Additional Information
All your information will be kept confidential according to EEO guidelines. Compensation
Pay Range: $18.17 - $23.05 Other Compensation (if applicable): Review the 2025-2026 UMMS Benefits Guide Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at careers@umms.edu.
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University of Maryland Upper Chesapeake Health (UM UCH) offers residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience. UM UCH is a community-based, integrated, non-profit health system whose vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We provide high quality care to all and work with the community and other health organizations to promote health and education. UM UCH owns and operates several facilities and entities in the region, including UM HMH, UM UCMC, the Upper Chesapeake Health Foundation, the Kaufman Cancer Center, and the Senator Bob Hooper House. Job location details and facility responsibilities will be determined by UMMS facilities as needed. General Summary
Under general supervision, responsible for processing the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. Responsible for triaging routine financial clearance work. Principal Responsibilities And Tasks
The following descriptions outline the general nature and level of work performed by personnel in this classification and are not exhaustive. Process administrative and financial components of financial clearance, including validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share and financial assistance referrals. Initiate and track referrals, insurance verification and authorizations for all encounters. Utilize third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles. Work directly with physician office staff to obtain clinical data needed to acquire authorization from carrier. Input information online or call carrier to submit requests for authorization; provide clinical backup for tests and document approval or pending status. Identify issues and problems with referral/insurance verification processes; analyze current processes and recommend solutions and improvements. Review and follow up on pending authorization requests. Coordinate and schedule services with providers and clinics. Research delays in service and discrepancies of orders. Assist management with denial issues by providing supporting data. Pre-register patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing. Develop and maintain working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services. Assist Medicare patients with the Lifetime Reserve process where applicable. Review previous day admissions to ensure payer notification upon observation or admission. Must be willing to travel between facilities as needed (applies to specific UMMS facilities). Performs other duties as assigned. Qualifications
Education and Experience
High School Diploma or equivalent is required. Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience. Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred. Knowledge, Skills And Abilities
Knowledge of medical and insurance terminology. Knowledge of medical insurance plans, especially managed care plans. Ability to understand, interpret, evaluate, and resolve basic customer service issues. Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies. Intermediate analytical skills to resolve problems and provide patients and referring physicians with information and assistance with financial clearance issues. Basic working knowledge of UB04 and Explanation of Benefits (EOB). Some knowledge of medical terminology and CPT/ICD-10 coding. Demonstrate dependability, critical thinking, and creativity and problem-solving abilities. Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred. Knowledge of the Patient Access and hospital billing operations of Epic preferred. Additional Information
All your information will be kept confidential according to EEO guidelines. Compensation
Pay Range: $18.17 - $23.05 Other Compensation (if applicable): Review the 2025-2026 UMMS Benefits Guide Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at careers@umms.edu.
#J-18808-Ljbffr