Financial Clearance Representative II

About the role

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. The 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.

Responsibilities

• Represent the values of TriHealth and complete all tasks efficiently and effectively
• Meet departmental goals for accounts financially cleared per work day
• Work independently to prioritize workload, follow designated departmental processes and workflows to complete daily tasks
• Work independently at home or outside of normal department hours to determine health plan requirements for add-on cases
• Act as subject matter expert for the department and help coach and mentor less experienced team members
• Manage multiple tasks simultaneously and adjust to issues as needed in a dynamic work environment
• 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)
• Obtain medical information from physician office
• Verify authorization/pre-certification requirements are met for all applicable cases
• Financially screen and communicate outcomes to responsible parties, including informing patients with inadequate insurance coverage and referring the patient or patient representative to financial counselors for assistance
• Using online payment estimator, perform initial financial screening, maintain appropriate records of financial screening results, and document appropriately in the system
• Meet 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
• Assist patients with clinically related authorization questions

Requirements

• High School Degree
• Medical terminology course or equivalent knowledge
• Knowledge of medical terminology, insurance vocabulary and processes
• Knowledge of 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 in 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 in technical healthcare
• Must have one year experience in insurance verification or precertification
• Experience with automated patient account systems or online verification systems

Benefits

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

Schedule

Full-Time (80 Hours Bi-Weekly), Day Shift, No Weekend, Holiday or On Call Commitment. Location: Good Samaritan Hospital.

Working Conditions

• Climbing – Rarely
• Concentrating – Consistently
• Continuous Learning – Frequently
• Hearing: Conversation – Consistently
• Hearing: Other Sounds – Rarely
• Interpersonal Communication – Consistently
• Kneeling – Rarely
• Lifting
• Lifting 50+ lbs – Rarely
• Lifting 11–50 lbs – Rarely
• Pulling – Rarely