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 patient experience and the billing process for hospital services.

Responsibilities

• Performs insurance eligibility and benefit verification using EDI transactions, payer web access, and direct calls, documenting information in the EMR system.
• Determines next steps based on verification outcomes (e.g., Self-Pay designation, financial counseling referral).
• Identifies the need for service authorizations (pre-certifications, third-party authorizations, referrals) and coordinates with physicians and Case Management/Utilization Review.
• Informs patients/guarantors of financial liabilities and collects co-payments, co-insurances, deductibles, deposits, and outstanding balances during pre-registration.
• Calculates patient liabilities, provides financial education, and refers patients to financial counseling as needed.
• Documents payments and 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 cases with scheduling or ancillary department staff when diagnosis or procedures require further detail.
• Prepares special reports as directed (e.g., patient service time, call volume).
• Serves as relief support or resource for training new employees, including cross-training 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 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.
• 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.

Qualifications

• Associate’s degree preferred.
• Comprehensive knowledge of scheduling with mastery in at least three (3) or more modalities.
• Three (3) years of scheduling experience in an acute care setting.
• Three (3) years of insurance verification experience.

Physical & Mental Requirements

• Occasional (1% - 33%): Exposure to unpleasant conditions (sight, touch, sound, smell), fumes, odors, dust, mists, gases, biohazards, mechanical/electrical hazards, radiation, sharp objects, infectious waste, diseases, interruptions, shifting priorities, and stressful situations.
• Frequent (34% - 66%): Ability to follow tasks through to completion, understand complex ideas, remember multiple tasks over long periods, work on concurrent tasks, climb, kneel, crouch, and operate foot controls.
• Continuous (67% - 100%): Ability to read small print, hear sounds and speech patterns, give/receive verbal instructions (in-person, phone, or device) with background noise, perform manual dexterity activities, use a computer, sit with varied physical positions, comply with policies, and provide emergency assistance.

Training is uninterrupted for 4 weeks.