What are the responsibilities and job description for the CLINICAL FINANCIAL CLEARANCE SPECIALIST position at MU Health?
Shift : Monday - Friday, 8am - 4 : 30pm
Department : Financial Clearance - ability to work from home after training and productivity standards are met
Compensation :
- Base Pay Range : $27.21 - $42.99 per hour, based on experience
ABOUT THE JOB
MU Health Care is looking for a Clinical Financial Clearance Specialist. As the ideal candidate, you'll join our dynamic team to ensure the smooth financial clearance of elective procedures, aligning perfectly with insurance coverage and securing necessary authorizations. Your commitment to excellence will shine as you navigate the intricate landscape of third-party and government payer billing regulations. Collaboration is your forte - you'll work closely with providers, office staff, and various departments to guarantee accurate and timely authorizations for scheduled procedures. Your expertise will be key as you extract vital clinical data and validate payer sources, all while upholding our commitment to the highest standards of care. This is your chance to make a meaningful impact at MU Health Care and join us in shaping a healthier future.
ABOUT MU HEALTH CARE
MU Health Care is a growing academic health system in mid-Missouri comprised of multiple hospitals - including the region's only Level 1 Trauma Center and region's only Children's Hospital - and over 90 specialty clinics located throughout the region.
As an MU Health Care employee, you'll be part of an exceptional team committed to our mission of saving and improving lives. Our core values of inclusion, respect, service, discovery, responsibility and excellence foster a collaborative work environment where you can grow your career.
Learn more about MU Health Care.
Learn more about living in mid-Missouri.
EMPLOYEE BENEFITS
DETAILED JOB DESCRIPTION
Provide upfront financial clearance of elective procedures / services to ensure insurance coverage is verified, required prior authorization / pre-certification is obtained and procedure / service encounters are financially cleared prior to service.
Adhere to third-party and government payer billing and reimbursement guidelines as well as department performance standards and policies and procedures.
Work closely with providers, office staff and various departments to ensure accurate and timely authorizations for scheduled procedures.
Determine appropriate clinical details to enter / extract data for scheduled surgical procedures for prior authorization.
Process verbal and written physician, department, and payer requests by obtaining clinical data for prior authorization; act as a liaison for provider / patient as necessary.
Validate payer source, obtain pre-certification and / or prior authorization by reviewing clinical data and documentation against InterQual and Milliman Care Guidelines (MCG) criteria and / or payer guidelines against planned level of care to validate, if appropriate.
May complete unit / department specific duties as outlined in department documents.
KNOWLEDGE, SKILLS, & ABILITIES
Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.
Excellent interpersonal, written, and verbal skills.
Ability to effectively communicate with a variety of individuals including physicians and clinical team members.
Proficient in Microsoft Office and in personal computer use.
Typing ability of 30 words per minute. REQUIRED QUALIFICATIONS
Experience in documentation review, quality, ICD-10 coding, and Current Procedural Technology (CPT).
Respiratory Care Practitioner (RCP) or (RCP-T) licensure by the Missouri Respiratory Care board; or
Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days
PREFERRED QUALIFICATIONS
Broad clinical expertise and direct contact with physicians.
Additional license / certification requirements as determined by the hiring department.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and / or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs. Equal Opportunity Employer
The University of Missouri System is an Equal Opportunity Employer. Equal Opportunity is and shall be provided for all employees and applicants for employment on the basis of their demonstrated ability and competence without unlawful discrimination on the basis of their race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law. This policy applies to all employment decisions including, but not limited to, recruiting, hiring, training, promotions, pay practices, benefits, disciplinary actions and terminations. For more information, visit
All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law.
Salary : $27 - $43
