What are the responsibilities and job description for the Financial Clearance Specialist I - Hospital Revenue Cycle - On Site Work Schedule position at Alaska Native Tribal Health Consortium (ANTHC)?
The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary
Financial Clearance Specialists are responsible for obtaining necessary approvals from insurance providers before medical services or procedures are performed. This includes reviewing and verifying insurance information, ensuring proper documentation, and ensuring that services meet the criteria for authorization. Specialists will collaborate with healthcare providers and insurance companies to ensure smooth and timely authorization processes.
Responsibilities
All
Insurance Verification: Accurately verifies patient insurance coverage, confirming eligibility and benefits. Determines the need for pre-authorization for specific medical procedures, services, or treatments, ensuring all necessary information is collected promptly to avoid delays.
Pre-Authorization Approvals: Proactively secures pre-authorization from insurance providers for planned medical treatments, surgeries, and services. Utilizes strong knowledge of insurance protocols and clinical requirements to streamline the approval process and minimize processing time.
Document Management: Ensures the timely and accurate submission of all necessary documentation, including medical records, to insurance companies to facilitate authorization requests. Takes ownership of ensuring complete and proper documentation is provided to support each case.
Collaboration: Works closely with healthcare providers—including physicians, nurses, and specialists—to gather required medical documentation, ICD-10 codes, and clinical details for submission. Promptly communicates with ordering providers to address authorization or certification denials, ensuring a seamless workflow and minimizing delays.
Communication: Serves as a primary liaison between the healthcare facility, medical providers, and insurance companies. Facilitates clear and consistent communication, including submitting and following up on authorization requests, and works to resolve issues or concerns that may arise during the process.
Compliance: Ensures that all authorization processes adhere to insurance protocols, healthcare regulations, and organizational policies. Maintains up-to-date knowledge of evolving insurance requirements and regulatory guidelines to ensure ongoing compliance.
Record Maintenance: Maintains meticulous records of all interactions, authorizations, approvals, and denials within the EHR system and financial clearance tools. Ensures comprehensive documentation is kept for reference, audit purposes, and compliance, while supporting continuous process improvement.
Financial Clearance Specialist II
Advanced Financial Clearance Processing: Leads pre-authorization process, utilizes in-depth knowledge of insurance protocols and clinical guidelines to anticipate potential challenges and reduce approval timelines.
Advanced Communication and Problem Solving: Serves as a senior liaison between the organization and insurance carriers, ensuring clear and consistent communication regarding complex or time-sensitive authorization cases.
Advanced Team Support: Leads training initiative and shares insight to keep the team informed of evolving requirements. Acts as a resource for resolving escalated issues related to authorization or certification denials, ensuring a collaborative and efficient workflow. Identifies opportunities for process optimization and works with Manager to implement innovative solutions to enhance efficiency and accuracy.
Other Information
KNOWLEDGE and SKILLS:
All
All
High school diploma or equivalent required.
Minimum Experience Qualification
All
One (1) year of medical office, patient registration or insurance verification experience. An equivalent combination of relevant training or education may be substituted.
Financial Clearance Specialist II
Three (3) years of proven experience in both insurance verification and/or pre-authorization, with a track record of handling complex cases.
Preferred Education Qualification
Associates degree in related field or equivalent combination of training or education may be substituted.
Preferred Experience Qualification
All
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
- Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
- Cost-Share Dental and Vision Insurances
- Discounted Pet Insurance
- Retirement Contributions with Pre-Tax or Roth options into a 403(b).
- 401(a) ANTHC Retirement Plan: After one year of employment, ANTHC will begin making matching contributions of up to 5% of your eligible pay, based on your own contributions. In addition, you may be eligible for an annual discretionary contribution of up to 3% from the employer.
- Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
- Eleven Paid Holidays
- Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment
- Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
- Flexible Spending Accounts for Healthcare and Dependent Care.
- Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
- On-Site Child Care Facility with expert-designed classrooms for early child development and preschool.
- Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
- Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
- On-Site Training Courses and Professional Development Opportunities.
- License and certification reimbursements and occupational insurance for medical staff.
- Gym Access to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
- Emergency Travel Assistance
- Education Assistance or Education leave eligibility
- Discount program for travel, gym memberships, amusement parks, and more.
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary
Financial Clearance Specialists are responsible for obtaining necessary approvals from insurance providers before medical services or procedures are performed. This includes reviewing and verifying insurance information, ensuring proper documentation, and ensuring that services meet the criteria for authorization. Specialists will collaborate with healthcare providers and insurance companies to ensure smooth and timely authorization processes.
Responsibilities
All
Insurance Verification: Accurately verifies patient insurance coverage, confirming eligibility and benefits. Determines the need for pre-authorization for specific medical procedures, services, or treatments, ensuring all necessary information is collected promptly to avoid delays.
Pre-Authorization Approvals: Proactively secures pre-authorization from insurance providers for planned medical treatments, surgeries, and services. Utilizes strong knowledge of insurance protocols and clinical requirements to streamline the approval process and minimize processing time.
Document Management: Ensures the timely and accurate submission of all necessary documentation, including medical records, to insurance companies to facilitate authorization requests. Takes ownership of ensuring complete and proper documentation is provided to support each case.
Collaboration: Works closely with healthcare providers—including physicians, nurses, and specialists—to gather required medical documentation, ICD-10 codes, and clinical details for submission. Promptly communicates with ordering providers to address authorization or certification denials, ensuring a seamless workflow and minimizing delays.
Communication: Serves as a primary liaison between the healthcare facility, medical providers, and insurance companies. Facilitates clear and consistent communication, including submitting and following up on authorization requests, and works to resolve issues or concerns that may arise during the process.
Compliance: Ensures that all authorization processes adhere to insurance protocols, healthcare regulations, and organizational policies. Maintains up-to-date knowledge of evolving insurance requirements and regulatory guidelines to ensure ongoing compliance.
Record Maintenance: Maintains meticulous records of all interactions, authorizations, approvals, and denials within the EHR system and financial clearance tools. Ensures comprehensive documentation is kept for reference, audit purposes, and compliance, while supporting continuous process improvement.
Financial Clearance Specialist II
Advanced Financial Clearance Processing: Leads pre-authorization process, utilizes in-depth knowledge of insurance protocols and clinical guidelines to anticipate potential challenges and reduce approval timelines.
Advanced Communication and Problem Solving: Serves as a senior liaison between the organization and insurance carriers, ensuring clear and consistent communication regarding complex or time-sensitive authorization cases.
Advanced Team Support: Leads training initiative and shares insight to keep the team informed of evolving requirements. Acts as a resource for resolving escalated issues related to authorization or certification denials, ensuring a collaborative and efficient workflow. Identifies opportunities for process optimization and works with Manager to implement innovative solutions to enhance efficiency and accuracy.
Other Information
KNOWLEDGE and SKILLS:
All
- Working knowledge of health insurance protocols.
- Excellent communication and interpersonal skills.
- Proficiency with electronic health records (EHR) and insurance portals.
- Detail-oriented with strong organizational skills.
- Ability to manage multiple tasks and deadlines.
- Ability to work independently with minimal supervision and to manage multiple priorities.
- Skill in grammar, spelling, sentence structure and effective business communications.
- Skill in oral and written communication.
- Skill in operating a personal computer utilizing a variety of applications.
All
High school diploma or equivalent required.
Minimum Experience Qualification
All
One (1) year of medical office, patient registration or insurance verification experience. An equivalent combination of relevant training or education may be substituted.
Financial Clearance Specialist II
Three (3) years of proven experience in both insurance verification and/or pre-authorization, with a track record of handling complex cases.
Preferred Education Qualification
Associates degree in related field or equivalent combination of training or education may be substituted.
Preferred Experience Qualification
All
- Customer service experience.
- Previous healthcare prior authorization experience.
- Financial Clearance Specialist II
- Advanced knowledge of healthcare regulations, medical terminology, coding systems, and insurance protocols.
- Strong problem-solving skills and the ability to navigate high-pressure or escalated situations effectively.
