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 verification, elective short procedure/inpatient verification, urgent admission verification, or scheduling. Ensures financial clearance and collection for all pre-service accounts prior to the date of service. Initiates the patient experience and billing process for hospital services.

Responsibilities

• Performs insurance eligibility and benefit verification using EDI transactions, payer web access, or direct calls, documenting results in the EMR system.
• Determines next steps based on verification outcomes (e.g., Self-Pay designation, financial counseling referral).
• Identifies need for service authorizations (pre-certifications, third-party authorizations, referrals) and coordinates with physicians and Case Management/Utilization Review personnel.
• Informs patients/guarantors of financial liabilities and collects co-payments, co-insurances, deductibles, deposits, and outstanding balances at pre-registration.
• Calculates patient liabilities, provides financial education, and refers patients to financial counseling as needed.
• Documents payments/actions in the patient accounting system and provides payment receipts.
• Validates medical necessity (LMRP/LCD review) for Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Clarifies diagnoses or procedures with scheduling/ancillary department staff when needed.
• Prepares special reports for management (e.g., patient service time, call volume) as directed.
• Serves as relief support or resource for training new employees; cross-trains in various functions to assist departmental operations.
• Performs other duties as assigned by the Manager.
• Maintains knowledge of Federal, State, and local laws, Trinity Health’s Organizational Integrity Program, Standards of Conduct, and relevant policies/procedures.

Requirements

• High School Diploma or equivalent.
• Minimum of five (5) years of financial clearance/authorization experience in an acute care setting.
• 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, department performance standards, and policies/procedures.

Physical & Mental Requirements

• Exposure to unpleasant conditions: Occasional (sight, touch, sound, smell, fumes, odors, dust, mists, gases, biohazards, mechanical/electrical hazards, radiation, sharp objects).
• Exposure to noise, infectious waste, diseases, and stressful situations: Occasional.
• Interruptions and shifting priorities: Frequent.
• Cognitive demands: Continuous ability to follow tasks through completion, understand complex concepts, remember multiple tasks, and work on concurrent projects.
• Sensory demands: Continuous ability to read small print, hear sounds/voice patterns, and communicate verbally (in-person, phone, or device) with background noise.
• Manual dexterity and physical activities: Frequent grasping/handling; occasional climbing, kneeling, crouching, or foot controls.
• Computer/technology use: Continuous.
• Sitting and physical positioning: Continuous ability to vary/adjust position or activity.
• Compliance: Continuous adherence to Trinity Health’s Code of Conduct, policies, and procedures.
• Emergency assistance: Occasional.

Training

Required training is an uninterrupted 4-week period.