Eligibility & Financial Clearance Specialist

Job description

Clearance Specialist
$22-24/HR
Gaithersburg, MD
Shift – (M-Th: 8-4:45pm & Fri: 8-3:30) Clearance Specialist Overview:
The Clearance Specialist is responsible for ensuring patients are financially cleared prior to services being rendered. This role verifies insurance eligibility, secures prior authorizations, analyzes benefits coverage, and determines patient financial responsibility to prevent delays in care and billing issues. The specialist works within Cerner and Experian systems to document accurate coverage details and support revenue cycle operations. Clearance Specialist Roles and Responsibilities:

• Verify patient insurance eligibility and benefits prior to services being rendered.
• Utilize insurance carrier portals to obtain prior authorizations and confirm coverage details.
• Identify authorization requirements and ensure approvals are secured in a timely manner.
• Analyze insurance benefits to determine patient financial responsibility, including deductibles, co-pays, co-insurance, and out-of-pocket estimates.
• Communicate financial obligations clearly and professionally to patients.
• Collect patient payments and arrange payment plans when applicable.
• Accurately document eligibility verification, authorizations, and financial information within Cerner.
• Utilize Experian (Cerner-based) tools to support financial clearance processes.
• Ensure compliance with HIPAA regulations and maintain strict confidentiality of protected health information (PHI).
• Collaborate with scheduling, billing, and clinical teams to prevent service delays due to authorization or coverage issues.
• Maintain productivity and accuracy standards in a high-volume healthcare environment.
• Participate in weekly virtual huddles and team meetings (camera-enabled).
• Maintain a dedicated HIPAA-compliant home workspace when working remotely.
• Adapt to hybrid work environment, including onsite training and remote work as assigned.

Qualifications

• High School Diploma required
• 2–5 years of experience in insurance verification, prior authorizations, financial clearance, or healthcare revenue cycle
• Experience with Cerner and Experian (Cerner-based system)
• Strong understanding of insurance plans, coverage verification, and patient financial responsibility
• Ability to work independently while maintaining attention to detail and compliance standards