Role Overview
This position is responsible for securing insurance authorizations and verifying patient eligibility to support seamless access to care. The specialist works closely with insurers, healthcare providers, and internal departments to resolve coverage issues and ensure services are approved before treatment.
Key Responsibilities
- Obtain prior authorizations through online portals, phone calls, and fax submissions across various insurance plans
- Review clinical documentation to understand provider orders and submit accurate authorization requests
- Communicate with insurance companies, primary care offices, and patients to exchange necessary clinical and coverage details
- Respond to payer inquiries and patient correspondence regarding insurance status and requirements
- Use systems such as Trace, pixcert, Soarian, and XR (Cerner) to maintain compliance with legal and privacy standards
- Manage multiple worklists daily, prioritizing tasks to meet deadlines and support timely patient appointments
- Follow up on pending cases by checking online submissions, reviewing faxes, and contacting payers
- Submit appeals or reconsiderations when initial coverage is denied or limited
- Document all actions thoroughly and consistently to ensure clarity and accountability
- Coordinate with Clinical Trial Coordinators, the Appointment Center, and the Business Office to address patient-specific needs
- Maintain productivity aligned with departmental goals and participate in performance feedback sessions
- Meet quality assurance benchmarks and adhere to operational guidelines and procedural scorecards
Qualifications
- Six months of experience as a Financial Clearance Specialist I or II, meeting advancement criteria for Level III
- Must obtain HFMA CRCR certification within 12 months of hire or transfer
- Alternatively, three years of recent experience in patient registration, insurance verification, or pre-certification within a healthcare or insurance setting
Work Environment
This is an onsite role requiring daily presence to ensure consistent workflow and collaboration. The organization is recognized nationally for workplace excellence and innovation in digital health, with a mission centered on advancing cancer care and research.
