Financial Clearance Representative II

Join TriHealth as a Financial Clearance Representative II!

Join a team that plays a critical role in helping patients access the care they need. As a Financial Clearance Specialist, you'll use your knowledge of insurance verification, authorizations, and patient benefits to ensure a seamless experience for patients while supporting the overall financial health of the organization. This role is ideal for someone who enjoys problem-solving, working with healthcare technology, and collaborating with providers, patients, and insurance carriers.

At TriHealth , you'll be part of an organization committed to improving the health of the community while investing in its team members. We offer a collaborative environment, opportunities for professional growth, and the chance to make a meaningful impact every day by helping patients navigate the financial aspects of their healthcare journey.

Apply today and grow your career with a team that truly values you.

Location:

- Good Samaritan Hospital

Work Schedule:

- Full-Time (80 Hours Bi-Weekly)
- Day Shift
- No Weekend, Holiday or On Call Commitment

Benefits:

TriHealth offers a comprehensive benefits package - including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement. Please view our benefits page https://careers.trihealth.com/what-we-offer/benefits

Job Requirements

- High School Degree
- Medical terminology course or equivalent knowledge
- Knowledge of Medical terminology
- Insurance vocabulary and Processes
- Government and non-government third party benefits and coverage rules
- Understanding of the impact financial clearance services have on revenue cycle operations and financial performance
- 1-2 years’ experience Customer Service Healthcare
- Dedication to treating both internal and external constituents as clients and customers
- Maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality
- Background in managed care or patient billing
- 1-2 years’ experience Technical Healthcare
- Must have one year experience in insurance verification or precertification experience
- Experience with automated patient account systems or online verification systems

Job Overview
This position is responsible for verifying patient insurance, confirming benefits eligibility, performing authorization and pre-certification, calculating and estimating patient liability, and/or notification as required by third party coverage providers. Purpose of this job is to verify that TriHealth patient insurance information is accurate and up to date so payment will be received for services rendered. Additionally, this position requires the ability to discuss complex medical terms and prior treatment with physician office staff.

Job Responsibilities:

- The ability to represent the values of TriHealth and complete all tasks efficiently and effectively. Able to meet the departmental goals for accounts financially cleared per work day. Works independently to prioritize workload, follows designated departmental processes and workflows to complete daily tasks. Ability to work independently at home or outside of normal department hours to determine health plan requirements for add-on cases. Act as the subject matter expert for the department and will help coach and mentor less experienced team members. The ability to manage multiple tasks simultaneously and adjust to issues as needed in a dynamic work environment.
- Ability to conduct patient verification tasks including: screening and identifying insurance problems such as non-network coverage or inability to obtain precertification prior to test, surgery or procedure being performed, completing all financial clearance steps prior to services being rendered (excluding situational outliers). Obtains medical information from physician office. Verifies authorization/pre-certification requirements are met for all applicable cases.
- Ability to financially screen and communicate outcomes to responsible parties, which includes informing patients with inadequate insurance coverage and referring the patient or patient representative to financial counselors for assistance. Using online payment estimator, performs the initial financial screening, maintaining appropriate records of financial screening results and documenting appropriately in the system.
- Meets all customer service guidelines including exceptional customer service skills and phone etiquette, dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality. Ability to assist patients with clinically related authorization questions.

Other Job-Related Information

Working Conditions

Climbing - Rarely
Concentrating - Consistently
Continuous Learning - Frequently
Hearing: Conversation - Consistently
Hearing: Other Sounds - Rarely
Interpersonal Communication - Consistently
Kneeling - Rarely
Lifting <10 Lbs - Rarely
Lifting 50+ Lbs - Rarely
Lifting 11-50 Lbs - Rarely
Pulling - Rarely
Pushing - Rarely
Reaching - Occasionally
Reading - Consistently
Sitting - Frequently
Standing - Occasionally
Stooping - Occasionally
Talking - Consistently
Thinking/Reasoning - Consistently
Use of Hands - Consistently
Color Vision - Rarely
Visual Acuity: Far - Consistently
Visual Acuity: Near - Consistently
Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors
At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS…
•Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
•Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
•Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS…
•Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
•Offer patients and guests priority when waiting (lines, elevators)
•Work on improving quality, safety, and service

Respect: ALWAYS…
•Respect cultural and spiritual differences and honor individual preferences.
•Respect everyone’s opinion and contribution, regardless of title/role.
•Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS…
•Value the time of others by striving to be on time, prepared and actively participating.
•Pick up trash, ensuring the physical environment is clean and safe.
•Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS…
•Acknowledge wins and frequently thank team members and others for contributions.
•Show courtesy and compassion with customers, team members and the community