Job Description

Northwestern Medicine is seeking an experienced Financial Clearance Specialist to support patient financial clearance and revenue cycle operations. This position is responsible for verifying patient demographics, insurance eligibility and benefits, coordinating insurance authorizations, and ensuring patients are financially cleared for scheduled services.

The ideal candidate will have strong knowledge of commercial insurance plans, Medicare and Medicaid regulations, and hands-on experience processing pre-certifications and authorizations. EPIC experience and previous healthcare experience are strongly preferred.

Key Responsibilities

• Collect, review, and verify patient demographic, insurance, financial, and clinical information.
• Respond to incoming telephone inquiries and assist patients with insurance-related questions.
• Verify insurance eligibility, coverage, and benefit levels using online insurance portals and telephone inquiries.
• Process insurance pre-certifications and obtain required authorizations for scheduled procedures, diagnostic exams, and services.
• Coordinate with insurance carriers, physician offices, and internal departments to obtain timely authorization approvals.
• Review patient records and physician orders to ensure required documentation and diagnosis information are available.
• Monitor assigned work queues and follow up on pending authorizations within insurance carrier deadlines.
• Document all verification, authorization, and patient communication activities accurately in EPIC.
• Identify and resolve insurance coverage, referral, and medical necessity issues.
• Communicate authorization requirements and potential financial responsibilities to patients when necessary.

Requirements

• MUST have previous pre-certification / prior authorization experience.
• Familiarity with commercial insurance plans and managed care products.
• Strong knowledge of Medicare and Medicaid rules and regulations.
• Experience verifying insurance eligibility and benefits.
• Strong computer skills and attention to detail.
• Excellent communication, customer service, and organizational skills.

Preferred Qualifications

• Previous experience working in a hospital or healthcare environment.
• Hands-on experience with EPIC.
• Experience with insurance verification, patient registration, and revenue cycle operations.
• Knowledge of medical terminology, CPT, and ICD-10 coding.