Revenue Cycle Specialist – Pre-Encounter Financial Clearance - Remote

Overview

The Revenue Cycle Specialist – Pre-Encounter Financial Clearance is responsible for completing all financial clearance activities prior to patient encounters and scheduled procedures. This role ensures accurate insurance eligibility and benefit determination, verifies coverage alignment with planned services, secures referrals and prior authorizations, and prepares compliant Good Faith Estimates (GFEs).

In Short

• Verify patient insurance eligibility and benefits prior to scheduled visits and procedures
• Analyze benefit design, including deductibles, copayments, coinsurance, out-of-pocket maximums, exclusions, and limitations
• Complete all required financial clearance activities within established timelines
• Obtain referrals and prior authorizations from external physician practices and insurance companies
• Apply a working knowledge of CPT, HCPCS, and ICD-10 coding to support benefit determinations
• Maintain awareness of payer and regulatory variations across multiple states
• Collaborate with internal revenue cycle teams and ambulatory surgery center leadership
• Accurately document eligibility, benefit analysis, authorizations, and financial clearance activities
• Support continuous process improvement initiatives related to pre-encounter financial clearance
• Work effectively within a team-based environment to support shared goals

Requirements

• High School diploma
• 2–4 years of revenue cycle management or medical financial clearance experience
• Working knowledge of CPT, HCPCS, and ICD-10
• Experience with commercial, Medicare, and Medicaid payers and authorization processes
• Demonstrated ability to research and apply payer policies
• Experience supporting physician professional or ambulatory surgical services
• Experience in ophthalmology, eye care or surgical specialties (preferred)
• Familiarity with No Surprises Act requirements and GFE workflows (preferred)
• Experience with practice management systems, EHRs, and payer portals (preferred)

Benefits

• Opportunity to work fully remote
• Collaborative team environment
• Engagement in process improvement initiatives
• Support for professional development in healthcare finance
• Exposure to multistate healthcare operations