FINANCIAL CLEARANCE SPECIALIST II at StrideCare in Location not listed

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.