RCM Financial Clearance Specialist bei Baylor Genetics

The primary responsibility of the RCM Financial Clearance Specialist is to ensure the timely and accurate financial clearance of patient accounts. The Specialist will focus primarily on resolving missing claim elements and ensuring the timely submission of clean claims to insurance companies. This role requires meticulous work and the ability to thrive in a fast-paced environment. The role requires meticulous work and the ability to thrive in a fast-paced environment, and attention to detail. This is a full-time position, Monday through Friday, with occasional overtime as needed.

Responsibilities: 

• Completes registration, via faxes, portal, etc., within the billing platform
• CRM (charge repository management) requests for coordination of benefit changes
• Manages patient insurance referral obligations, enters referrals, and links to appropriate charges
• Identifies and confirms valid coverage for an episode of care and/or specific service and location: contacts insurance companies and/or reviews electronic response summary and coverage discovery information to ensure the appropriate coverage is on the patient's record, and accurate claims can be sent out.
• Is attentive to and answers a high-volume worklist
• Communicates in a manner to ensure a positive patient or customer experience.
• Claim Error Processing / Efficiently analyze and resolve claim errors identified by the revenue cycle management system, including coding and billing 
• Collaborate with teammates to resolve errors and ensure compliance with policies and

Qualifications: 

• College degree preferred or equivalent experience of 5 plus years
• Minimum of 5 years of experience in a medical billing or financial clearance role.
• Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
• Working knowledge of insurance policies, billing procedures, and claim terminology.
• Excellent communication and people skills.
• Detail-oriented with strong analytical and problem-solving abilities.
• Preference will be given to qualified candidates with experience with laboratory billing software, including Telcor, Xifin or Quadax.

Skills:

• Strong knowledge of insurance guidelines, CPT/ICD-10 codes, and medical terminology.
• Excellent attention to detail and time management skills.
• Effective communication and problem-solving abilities.
• Proficiency in Microsoft Office Suite and healthcare software tools.