The Patient Financial Clearance Specialist (PC 3) is a key member of the Division of Dermatopathology’s revenue cycle team. The individual is primarily responsible for securing financial clearance for clinical laboratory patients and referring healthcare organizations. The PC 3 works closely with the lab’s accessioning team to verify patient insurance eligibility and coverage for each case, communicates with insurance providers to obtain required authorizations or referrals, and documents essent... more details
The Patient Financial Clearance Specialist (PC3) is a key member of the Division of Dermatopathology’s revenue cycle team. The individual is primarily responsible for securing financial clearance for clinical laboratory patients and referring healthcare organizations. The PC3 works closely with the lab’s accessioning team to verify patient insurance eligibility and coverage for each case, communicates with insurance providers to obtain required authorizations or referrals, and documents essential billing information in the laboratory information management system. The individual ensures that accurate and complete medical billing information for each case is promptly submitted to the lab’s medical billing agent.
Under the general direction of the revenue cycle supervisor, the PC3 works independently to resolve payment issues with commercial and government sources that provide healthcare coverage through numerous types of health plans. These plans include traditional indemnity or fee-for-service (FFS) plans, and managed care plans like health maintenance organizations (HMO), preferred provider organizations (PPO), and point-of-service (POS) plans. The incumbent must acquire an advanced understanding of payer requirements for the lab’s top payers, which include Medicare, Blue Cross, Aetna, Cigna, United Healthcare, Tricare, and Medicaid.
The PC3 is responsible for working a daily caseload of assigned insurance and authorization work queues. The PC3 works with the lab’s billing agent to rapidly fulfill requests for additional information (RAIs) for claims that cannot be filed. The PC3 acts quickly to resolve payer denial errors and takes corrective actions to reduce the occurrence of denials for preventable reasons such as incorrect demographic or plan information or no prior authorization.
The PC3 responds to incoming billing inquiries from patients, referring medical practices, other diagnostic labs, health plan providers, and the lab’s billing and collections agencies. The PC3 also works with the lab’s clinical teams and physician providers to support practice operations and customer service activities. Additionally, the PC3 is responsible for the maintenance of all revenue cycle clerical tasks such as data entry or scanning, and for routine communications.
The PC3 has a can-do attitude and a positive mindset. The successful incumbent is a motivated, self-reliant individual who works efficiently and understands the collective goal of the revenue cycle group. The PC3 is a team player who works well with the other revenue cycle staff and with the Division’s administrative staff, eg finance or marketing. The PC3 must have the ability to analyze and prioritize medical billing issues and to effectively communicate a wide variety of individuals, including patients, providers, and other clinicians.
The final salary and offer components are subject to additional approvals based on UC policy.
To see the salary range for this position (we recommend that you make a note of the job code and use that to look up): TCS Non-Academic Titles Search (ucop.edu)
Please note: The compensation ranges listed online for roles not covered by a bargaining unit agreement are very wide, however a job offer will typically fall in the range of 80% - 120% of the established mid-point. An offer will take into consideration the experience of the final candidate AND the current salary level of individuals working at UCSF in a similar role.
For roles covered by a bargaining unit agreement, there will be specific rules about where a new hire would be placed on the range.
To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html
Work experience at a University of California academic health center
Work experience in a dermatology medical practice or pathology clinical lab
Work experience in a medical billing environment or with a healthcare industry payer
Knowledge of medical terminology and professional fee coding
Advanced understanding of payer requirements for Medicare, Medicaid, and HMOs/PPOs
Familiarity with the Health Insurance Portability and Accountability Act (HIPAA)
High school graduate or equivalent with four years of work experience; or bachelor’s degree with six months of work experience; or equivalent combination of education and experience
Strong computer skills including intermediate proficiency with Microsoft Excel and Word
Ability to sit at a computer terminal with telephone headphones for extended period of time
Ability to navigate through insurance verification and health plan portals, and POS payment systems
Ability to prioritize case workload, solve billing problems, and meet service time standards
Possess excellent communication skills including listening, observing, speaking, and writing
Provide courteous service to all stakeholders including patients, providers, and other clinicians
Ability to complete assigned caseload efficiently and solve problems with minimal supervision
Reliable, consistent work attendance and punctuality
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