Financial Clearance Specialist II - Rev Cycle

Position Summary:

The RCM Financial Clearance Specialist II is 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

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.