Pre-Visit Financial Clearance Specialist

About the Role The Pre-Visit Financial Clearance Specialist is responsible for ensuring a seamless patient experience by reviewing and preparing financial and insurance details before scheduled appointments. This role includes verifying insurance eligibility, securing necessary authorizations (such as BWC, VA, and commercial insurance), and collecting outstanding patient balances in advance. Additionally, this specialist will work eQueued claims, addressing insurance or eligibility failures, correcting errors, and resubmitting claims. This individual will also cross-train to provide backup support for the Insurance and Eligibility Specialist when needed. What You’ll Be Doing Pre-Visit Financial Review & Patient Communication:

• Review patient charts prior to appointments to ensure all financial and insurance requirements are met.
• Identify outstanding patient balances and proactively contact patients to collect payments before their visit.
• Verify insurance coverage and benefits, ensuring accurate documentation in the EMR system.
• Check for required authorizations, including the Bureau of Workers' Compensation (BWC), Veterans Affairs (VA), and commercial payers, ensuring they are secured before the appointment.
• Notify front desk staff and providers of any missing financial or insurance-related information that could impact the patient’s visit. Patient Balance Collection & Financial Responsibility:
• Actively collect outstanding balances via phone, online payment options, and in-office payments.
• Educate patients on their financial responsibilities, including copays, deductibles, and outstanding balances.
• Offer and facilitate payment plan options when applicable.
• Document all collection efforts and patient communications within the EMR system. Insurance & Claims Resolution:
• Monitor and work eQueued claims for insurance or eligibility failures, correcting errors and resubmitting claims to prevent denials.
• Investigate and resolve claim rejections related to missing or incorrect insurance details.
• Communicate with payers to determine reasons for claim denials and take corrective actions.
• Update patient accounts with accurate insurance information before claim resubmission. Collaborate with the billing team to ensure claims are processed correctly and payments are received in a timely manner. Authorization & Eligibility Verification:
• Confirm that all necessary pre-authorizations are in place before a patient’s visit to prevent delays and claim denials.
• Follow up on pending authorizations and escalate any issues as needed. Cross-Training & Backup Coverage:
• Serve as a backup for the Insurance and Eligibility Specialist, handling insurance verification, eligibility checks, and claim troubleshooting as needed.
• Assist in processing insurance verifications for upcoming appointments during staff absences. Collaboration & Process Improvement:
• Work closely with front desk, billing, and scheduling teams to improve financial transparency and patient satisfaction.
• Identify and suggest opportunities to improve pre-visit financial workflows and efficiency. What We Expect from You
• Education: High school diploma or equivalent required; Associate’s degree in healthcare administration, billing, or a related field preferred.
• Experience: Prior experience in medical office operations, revenue cycle management, insurance verification, claims resolution, or patient collections preferred.
• Strong attention to detail and ability to identify financial and insurance discrepancies.
• Knowledge of insurance plans, pre-authorizations, and claim submission processes.
• Experience with claim corrections, insurance rejections, and denial management.
• Proficiency in EMR systems (ModMed experience preferred).
• Excellent communication and interpersonal skills to interact professionally with patients, internal teams, and insurance representatives.
• Ability to problem-solve, work independently, and manage multiple priorities in a fast-paced environment. Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice
  
  

What We Are Offer You

At U.S. Urology Partners, we are guided by four core values. Every associate living the core values makes our company an amazing place to work. Here “Every Family Matters”

Compassion

Make Someone’s Day

Collaboration

Achieve Possibilities Together

Respect

Treat people with dignity

Accountability

Do the right thing

Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans, HSA / FSA, 401(k) matching, an Employee Assistance Program (EAP) and more.

About US Urology Partners

U.S. Urology Partners is one of the nation’s largest independent providers of urology and related specialty services, including general urology, surgical procedures, advanced cancer treatment, and other ancillary services. Through Central Ohio Urology Group, Associated Medical Professionals of NY, Urology of Indiana, and Florida Urology Center, the U.S. Urology Partners clinical network now consists of more than 50 offices throughout the East Coast and Midwest, including a state-of-the-art, urology-specific ambulatory surgery center that is one of the first in the country to offer robotic surgery. U.S. Urology Partners was formed to support urology practices through an experienced team of healthcare executives and resources, while serving as a platform upon which NMS Capital is building a leading provider of urological services through an acquisition strategy.

U.S. Urology Partners is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.