Financial Clearance Specialist II

Part-time, remote position.

About the role

Responsible for complex, high-dollar services including surgical, observation, and in-house services across multiple areas of verification: outpatient, elective short procedure/inpatient, and urgent admission verification or scheduling. Ensures financial clearance and collection for all pre-service accounts prior to the date of service. Initiates the overall patient experience and the billing process for hospital services.

Responsibilities

• Obtain and verify accurate insurance information, benefit validation, authorization, and preservice collections.
• Perform insurance eligibility/benefit verification using EDI transactions, payer web access, or direct calls, and document information within the EMR system.
• Determine next steps based on verification outcomes (e.g., Self-Pay designation, referral to financial counseling).
• Determine need for service authorizations (pre-certifications, 3rd party authorizations, referrals) and contact physicians or Case Management/Utilization Review personnel as necessary.
• Inform patients/guarantors of their financial liabilities and collect co-payments, co-insurances, deductibles, deposits, and outstanding balances at pre-registration.
• Calculate patient liabilities, provide financial education, and refer patients to financial counseling as required.
• Document payments/actions in the patient accounting system and provide payment receipts.
• Validate medical necessity (LMRP/LCD review) for Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Contact scheduling or ancillary department staff for clarification on cases requiring diagnosis or procedure/test details.
• Prepare special reports as directed by the Manager to document utilization of Pre-Service unit services and patient flow (e.g., patient service time, call volume).
• Serve as relief support or resource to train new employees, and cross-train in various functions to assist in smooth departmental service delivery.
• Perform other duties as assigned by the Manager.
• Maintain working knowledge of applicable Federal, State, and local laws, Trinity Health’s Organizational Integrity Program, Standards of Conduct, and other policies to ensure ethical and professional behavior.

Requirements

• Minimum of five (5) years of financial clearance/authorization experience in an acute care setting.
• High School Diploma or equivalent.
• Two (2) to five (5) years of experience in scheduling, financial clearance, or patient access.
• National certification in HFMA CRCR required within one (1) year of hire.
• Proficiency in Patient Registration/Patient Accounting systems and related software.

Qualifications

• Associate’s degree preferred.
• Comprehensive knowledge of scheduling with mastery in at least three (3) or more modalities and insurance verification processes.
• Three (3) years of scheduling experience in an acute care setting.
• Experience in complex facility-based ancillary testing across multiple facilities/states.
• Strong knowledge of third-party and government payer billing, reimbursement guidelines, and department performance standards.

Physical & Mental Requirements

• Occasional Exposure: Fumes, odors, dusts, mists, gases, biohazards/hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects), interruptions, shifting priorities, stressful situations, infectious waste, diseases, and conditions.
• Frequent Ability: Follow tasks through to completion, understand and relate to complex ideas/concepts, remember multiple tasks over long periods, work on concurrent tasks/projects, climb, kneel, crouch, and operate foot controls.
• Continuous Ability: Read small print, hear sounds/voice patterns, give/receive verbal instructions (in-person or via phone/computer), perform manual dexterity activities, use a computer/technology, sit with ability to adjust physical position, comply with policies/procedures, and provide emergency assistance.

Training is uninterrupted for 4 weeks.