Capitation Specialist Jobs (NOW HIRING)

The Financial Clearance Specialist IV is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete. Documentation of accurate insurance information, knowledge of insurance plans and authorization details to optimize reimbursement from the payer are required. The Financial Specialist IV is responsible for extended understanding of division of financial responsibility to accurately adjudicate Letters of agreement to help streamline the claim management process. By securing the mutually signed Letter of agreement provides legal document that outlines the intent of both parties and will provide the supporting documentation needed for appeals for all non-contracted payers for both Professional and Hospital services. The Specialist IV must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization.

Specialist IV must also determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Specialist IV are to conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's representative. Specialist IV must maintain compliance with HIPAA regulations as it pertains to the insurance processes. Specialist IV must maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry.

Financial Clearance Specialist IV must be proficient in hospital and professional contracted versus non-contract payers including interpretation of language specific to covered services. The specialist must also have an extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting.

Minimum Education:

HS Diploma or GED Required.

Minimum Experience/Knowledge:

Minimum (3) years of experience in a hospital, health plan or Physician office environment with extensive knowledge of contracted and non-contracted payers, division of financial responsibility, including the ability to articulate benefit negotiations as required when adjudicating a letter of agreement with a non-contracted payer. Proficient in submission of authorization for all service types rendered within a hospital and/or professional setting.

Knowledge of business office procedures. Knowledge of medical terminology and coding.

Knowledge of grammar, spelling, and punctuation to type patient information.

Extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting

Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.

Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills. Capable of working assigned shifts, overtime when approved.

Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.

Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.

Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.

Proficient in interpreting and completing insurance verification process for all types of payers including HMO's Commercial, Medi Cal and Senior Plans, Medi Cal, Medicare, PPO, POS, EPO, Capitation, Military, Workman Compensation.

As part of Keck Medicine of USC, USC Verdugo Hills Hospital is the only community hospital in the Foothills area of Los Angeles backed by an academic medical center. With its 40-year legacy of personalized care from expert physicians, experienced nurses and a dedicated staff the community has come to know and trust, USC-VHH brings patients the latest medical advancements and 24/7 emergency services. Join this world-class team providing highly-specialized care, up-to-the-minute research and innovative clinical trials.

The hourly rate range for this position is $26.00 - $34.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email atuschr@usc.edu. Inquiries will be treated as confidential to the extent permitted by law.

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