Financial Clearance & Insurance Authorization Sp 1 - 128989

UCSD Layoff from Career Appointment: Apply by 04/01/24 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.

Special Selection Applicants: Apply by 04/10/24. Eligible Special Selection clients should contact their Disability Counselor for assistance.

This position will be onsite at East Campus with the possibility of remote in the future.

This is a part time position - 50% Career.

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Financial Clearance and Insurance Authorization Specialist I is an experienced revenue cycle professional responsible for financially securing scheduled and unscheduled hospital and professional services by verifying insurance eligibility and benefits coverage, and by securing insurance pre-certification and/or authorization for inpatient and/or outpatient services.

The Specialist communicates the status of coverage/benefits verification and authorization directly with patients and providers, and facilities rescheduling of services as appropriate. The Specialist provides and collects estimated patient liability amounts.

• Demonstrated hospital and/or professional services pre-access or billing experience.

• Minimum of three (3) years of hospital and/or professional services pre-access or billing experience in an academic or other complex, multispecialty setting.

• May consider less than three (3) years of experience for candidates with a college degree.

• Solid understanding of principles of excellent customer service, customer communications, and/or problem resolution relevant to healthcare settings.

• Experience must include insurance eligibility and benefits coverage verification, obtaining pre-certification and/or authorization for medical services, and providing explanations and/or estimates of patient financial responsibility.

• Experience with insurance/benefits verification portals or other applications, and experience with Epic or other similar patient registration, scheduling and/or billing information systems.

• Thorough knowledge eligibility, covered benefits, medical necessity and pre-authorization rules for federal, state, and commercial third-party payers.

• Proven knowledge of medical terminology, CPT, ICD-10, HCPCS, NDC, and modifier codes, including impact on benefits eligibility, authorization, and reimbursements for medical services.

• Demonstrated ability to understand and interpret payer contract terms and insurance verification/benefits eligibility responses.

• Strong understanding of deductibles, coinsurance and non-covered benefits, and ability to derive accurate estimate of patient responsibility.

• Excellent ability to communicate effectively, verbally and in writing.

• Proficiency using Microsoft Office applications (including Outlook, Skype/Lync, Excel and Word).

• Community college or university courses in medical terminology, medical coding, finance or other relevant subject matter.

• NAHAM Certified Healthcare Access Manager, HFMA Certified Revenue Cycle Representative, and/or Certified Procedural Coder (CPC or CPC-H) certifications.

• A minimum of four (4+) or more years of relevant experience.

• Experience with both hospital and professional services pre-certification and authorization experience.

• Prefer experience with benefits verification and authorization initial and additional inpatient hospital days, inpatient and outpatient procedures, outpatient diagnostic services, provider consultations and other visits, prescription drugs, SNF, rehabilitation services, durable medical equipment, and home health.

• Experience working with Epic registration, scheduling and referral applications.

• Completion of organization-sponsored or professional organization training in principles of customer service, customer communications and/or problem resolution relevant to healthcare settings.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: $56,522 - $70,261 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $27.07 - $33.65

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community .

UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.