Financial Clearance Specialist II

Join UTHealth Houston's Revenue Cycle team as an RCM Financial Clearance Specialist II. In this role, you will be responsible for verifying insurance benefits and obtaining required authorizations and referrals to ensure financial clearance before patient services. This position supports new and established patients by ensuring accurate registration, eligibility, and authorization of services through effective communication with payers, providers, and patients. The Specialist also creates cost estimates and educates patients on financial responsibilities while maintaining compliance with internal policies and external regulations.

The ideal candidate will have insurance verification experience, knowledge of front-end registration processes, and to be able to work in a fast paced environment.  

Qualifications:

• 3+ years of insurance authorization, verification, or healthcare financial clearance experience
• Experience resolving complex insurance cases

• Epic experience preferred

   

Location: Remote within Texas
Training: 2-4 weeks onsite at 1851 Crosspoint Ave., Houston, TX 77054
Note: Occasional onsite meetings/training may be required. Lodging and mileage reimbursement are not provided.

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Once you join us you won't want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:  

• 100% paid medical premiums for our full-time employees  
• Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year) 
• The longer you stay, the more vacation you’ll accrue! 
• Longevity Pay (Monthly payments after two years of service) 
• Build your future with our awesome retirement/pension plan! 

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as... 

• Free financial and legal counseling 
• Free mental health counseling services 
• Gym membership discounts and access to wellness programs 
• Other employee discounts including entertainment, car rentals, cell phones, etc. 
• Resources for child and elder care 
• Plus many more! 

Position Key Accountabilities:

• Analyze benefit information and clinical documentation to ensure appropriate coverage and medical necessity per payer guidelines. The ability to perform all registration components from charge review to ensure accurate patient registration and compliance with payer requirements before claim submission.
• Obtain prior authorizations for services per insurance policies and initiate Peer-to-Peer (P2P) reviews as needed. Collaborate with clinical, scheduling, and financial teams for financial clearance. Communicate benefits and cost estimates with patients. In charge review function the ability to identify and update referral authorization numbers when applicable.
• Accurately input and maintain insurance data in Epic based on real-time eligibility response or payor portals; ensure insurance plan selection aligns with the UT Managed Care Payer Plan Tool.
• Identify and report trends in denials, payer issues, or workflow inefficiencies to support continuous improvement and leadership decision-making.
• Maintain compliance with HOOP policies, HIPAA, and payer guidelines.
• Performs other duties as assigned.

Certification/Skills:

• None

Minimum Education:

High School Diploma or equivalent required Associate's Degree in healthcare or business-related field preferred

Minimum Experience:

3 years experience in healthcare financial clearance, insurance verification, or a related revenue cycle role required

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This position is a security-sensitive position pursuant to Texas Education Code §51.215 and Texas Government Code §411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code §117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R. §791.4.

Residency Requirement:

Employees must permanently reside and work in the State of Texas.