Associate Insurance Representative
Sanford Health
Financial Clearance Specialist
Solaris Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Junior
About the role
- NO WEEKENDS, NO EVENINGS, NO HOLIDAYS We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package! GENERAL SUMMARY The Financial Clearance Specialist is responsible for ensuring patients are financially cleared prior to receiving services by verifying insurance eligibility and obtaining prior authorizations. This dual-function role ensures accurate documentation, compliance with payer guidelines, and supports timely and efficient patient care. The Specialist works closely with scheduling, clinical, and billing teams under the guidance of the Manager/Supervisor of Financial Clearance.
Requirements
- ESSENTIAL JOB FUNCTION/COMPETENCIES The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to: Verify insurance coverage and benefit information using payer portals, clearinghouses, and direct communication with insurers. Confirm plan status, effective dates, co-pays, deductibles, coinsurance, and authorization requirements. Accurately document verification results in the EHR and/or PM. Submit prior authorization requests for services, tests, and procedures based on payer requirements. Monitor and follow up on pending authorizations to avoid delays in patient care. Address denied or delayed authorizations with payers and escalate unresolved issues to the Supervisor as needed. Coordinate with clinical staff to gather and submit necessary documentation for authorization approval. Notify appropriate teams of coverage issues, authorization status, or patient financial risk. Communicate with patients regarding their insurance coverage, financial responsibilities, and authorization outcomes when appropriate. Collaborate with schedulers and front-desk teams to ensure appointments align with insurance requirements. Follow standardized workflows and documentation protocols as outlined by the Supervisor. Maintain accuracy and timeliness in all financial clearance documentation. Participate in daily team huddles and contribute to process improvement initiatives. Performs other position related duties as assigned. Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.
