Insurance Verification Specialist

Job Title: Financial Clearence Specialist

Duration: 3 Months

Location: Los Angeles, CA 90033

Must Have's:

• Insurance knowledge: Commercial, Medicare, Medi-cal, HMO vs PPO
• Insurance Verification & Authorization Experience
• Ability to verify insurance coverage and submit authorizations for medical services.
• Patient Counselling on Insurance Plans
• Must be able to clearly explain insurance benefits, gaps, and options to patients.
• Understanding of Transplant Benefits
• Solid knowledge of transplant-specific insurance coverage across various plans.
• Real-Time Problem Solving
• Must be capable of providing quick, accurate insurance guidance to patients and staff and analytical Skills
• Ability to analyse insurance information and communicate findings effectively.
• Strong Verbal & Written Communication
• Comfortable conveying complex information clearly to diverse audiences.
• Team Collaboration
• Expected to participate in multidisciplinary team meetings and contribute to case discussions.
• Process-Oriented
• Follows standardized steps for financial clearance and contributes to improving operational throughput.
• Tech Savvy
• Able to learn and use hospital/transplant-specific IT systems related to insurance and financial clearance.

• Nice-to-HavesEpic: Cerner, OTTR experience preferred (not required).
• Passport Eligibility Verification System knowledge preferred (not required).
• Bilingual Fluency
• Strongly preferred; enhances communication with diverse patient populations.
• Experience in Transplant or Hospital Settings
• Prior work in a transplant program or similar healthcare environment.
• Experience with Complex Insurance Cases
• Comfort handling under-insured patients or those with lapses in coverage.
• Familiarity with Financial Clearance Workflows
• Knowledge of operational processes to accelerate clearance timelines.
• Participation in Process Improvement Initiatives
• Experience contributing to improvements in patient care or workflow efficiency.

Responsibilities:

• Under the direction of the TFC supervisor, the transplant financial coordinator (TFC) is a designated member of the multidisciplinary transplant team.
• His/her primary function is to assure transplant patients' medical services are covered by insurance.
• This includes insurance verification, authorization submission, effective patient counselling of insurance plans, providing insurance guidance when patients have a lapse of insurance or are under-insured and solid
• understanding of the complexity of transplant benefits as dictated by different insurance coverage.
• S/he is responsible for accelerating patient financial clearance by following standardized process steps.
• The TFC is also expected to problem-solve in real time and provide appropriate insurance direction to patients and staff, as needed.
• The TFC will participate in team meetings and discussions related to complex cases, advancing operational throughput and process improvement to benefit patient care.
• S/he should possess analytic skills and be able to evaluate/analyse insurance information to effectively convey and communicate to others.
• S/he should have excellent verbal and written skills and an ability to easily learn hospital and transplant IT systems as they relate to financial clearance and insurance.
• Bilingual fluency is strongly preferred.