Financial Clearance Representative

Finance & Revenue Cycle Worcester, Massachusetts


Position at UMass Memorial Health Care

Everyone Is a Caregiver.

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.

Requisition #: 212226
Title: Financial Clearance Rep
Department: Revenue Cycle
Grade: ADM5
Posting Date: Feb 4, 2021
Shift: Days
Status: Non-Exempt
Union: SHARE
Hours: 40 hours
Shift Length: 8 hours
Location: UMass Memorial Medical Center – 67 Millbrook St, Worcester

Position Summary:

Performs a variety of complex duties utilizing insurance and payer knowledge to ensure that all outpatient clinic visits, same day surgeries and inpatient admissions are financially cleared prior to release of a claim to the insurance company. 

Major Responsibilities:
  • Verifies insurance eligibility utilizing available technologies, payer websites, or by phone contact with third party payers.
  • Ensures that correct insurance company name, address, plan, policy number and filing order are recorded in Soarian Financials.
  • Works payer exceptions work queues utilizing the HDX batch process. Alerts infusion areas of any pre–service insurance changes by adding encounters to the SharePoint list.
  • Contacts primary care physicians to obtain referrals for patients coming to the organization for specialty visits. Contacts patients when the primary care physician is not known in order to obtain referrals.
  • Enters insurance referrals into the IDX computer system.

Position Qualifications:



High School diploma or equivalent.



3+ years of business office or related insurance experience. Knowledge of third party requirements as they relate to insurance verification / authorization. Demonstrated ability to work with computerized systems such as a PC, Point of Service device and online interfaced systems. Must possess communication skills sufficient to interact with multiple departments and organizational ability to manage workload.

Standards of Respect: