Financial Clearance & Insurance Authorization Lead - 141750

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 Lead is a seasoned 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 Lead communicates the status of coverage/benefits verification and authorization directly with patients and providers, and facilities rescheduling of services as appropriate. The Lead estimates and collects patient liability amounts. The Lead serves as an Epic application super-user, participates in Epic change/upgrade end-user testing and training, researches and resolves authorization denials, and assists with root cause analysis and resolution of work flow issues. Position is at an expert level and serves as a mentor to other Specialists. Hospital and/or professional services pre-access or billing experience.

• Minimum of four (4) years of hospital and/or professional services pre-access or billing experience in an academic or other complex, multispecialty setting. Will consider less than three (3) years of experience for candidates with a college degree.

• 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.

• Must have experience with insurance/benefits verification portals or other applications, and successful completion of training on Epic patient registration and scheduling applications.

• Hospital and/or professional services pre-access or billing experience

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

• Five (5+) or more years of relevant experience preferred.

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

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

• 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.