Patient Financial Clearance Specialist

Pathology

Full Time

79333BR

Job Summary

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

Department Description

The Department of Pathology at UCSF aims to achieve the highest standards in patient care, research and education. The Department provides diagnostic pathology services in a wide variety of subspecialties with highly trained subspecialists who are recognized nationally and internationally for their expertise. The Department's research programs are diverse and interface with a wealth of basic and translational research programs that are a hallmark of UCSF. Our educational programs include a research-intensive academic residency program and fellowships in cytopathology, dermatopathology, gastrointestinal and liver pathology, gynecologic pathology, neuropathology and surgical pathology.

The faculty of the Division of Dermatopathology and Oral Pathology are internationally recognized for delivering expert analysis and interpretation of skin disease for referring physicians. Each specimen that passes through the clinical lab is issued a diagnosis by one of the Division's faculty physicians. The Division processes approximately 180,000 cases per year and is responsible for the billing and collection of payments from hundreds of different third-party payers and organizational clients.

Required Qualifications

• 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

Preferred Qualifications

• 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)

About UCSF

The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world's leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as our PRIDE values.

In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu

Join us to find a rewarding career contributing to improving healthcare worldwide.

Equal Employment Opportunity

The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Organization

Campus

Job Code and Payroll Title

004818 PRACTICE CRD 3

Job Category

Administrative Support, Support Services

Bargaining Unit

Teamsters Local 2010 - Clerical and Allied Services Unit (CX)

Employee Class

Career

Percentage

100%

Location

Mount Zion (SF)

Shift

Days

Shift Length

8 Hours

Additional Shift Details

Monday-Friday 8am-5pm