Financial Clearance Representative II

TriHealth • Cincinnati, OH

21h • Onsite

About The Position

The Financial Clearance Representative II verifies patient insurance and benefit eligibility, performs authorization and pre-certification activities, calculates and estimates patient liability, and provides notifications required by third-party coverage providers. The role ensures patient insurance information is accurate and up to date so TriHealth can receive payment for services rendered. It also involves discussing complex medical terminology and prior treatment with physician office staff.

The representative works independently to prioritize and complete daily tasks according to departmental processes and goals, including financial clearance targets. The position may require working from home or outside normal department hours to determine health plan requirements for add-on cases. As a departmental subject matter expert, the representative coaches and mentors less experienced team members while managing multiple tasks in a dynamic environment.

This is a full-time, day-shift position at Good Samaritan Hospital, scheduled for 80 hours bi-weekly. There is no weekend, holiday, or on-call commitment.

Requirements

• High school degree.
• Medical terminology course or equivalent knowledge; knowledge of medical terminology.
• Knowledge of insurance vocabulary and processes, including government and non-government third-party benefits and coverage rules.
• Understanding of how financial clearance services affect revenue cycle operations and financial performance.
• 1–2 years of customer service experience in healthcare.
• 1–2 years of technical healthcare experience.
• At least one year of experience in insurance verification or pre-certification.
• Experience with automated patient account systems or online verification systems.
• Background in managed care or patient billing.
• Dedication to treating internal and external constituents as clients and customers.
• Flexible customer service approach emphasizing satisfaction and quality.

Responsibilities

• Verify patient insurance information and confirm benefits eligibility.
• Perform authorization and pre-certification activities and verify requirements for applicable cases.
• Calculate and estimate patient liability and provide notifications required by third-party coverage providers.
• Identify insurance issues, including non-network coverage and inability to obtain pre-certification before a test, surgery, or procedure.
• Complete financial clearance steps before services are rendered, except for situational outliers.
• Obtain medical information from physician offices and assist patients with clinically related authorization questions.
• Financially screen patients, communicate outcomes to responsible parties, and refer patients or representatives with inadequate coverage to financial counselors.
• Use an online payment estimator for initial financial screening, maintain records of screening results, and document appropriately in the system.
• Meet departmental goals for accounts financially cleared per workday and follow designated processes and workflows.
• Work independently to prioritize workloads, including determining health plan requirements for add-on cases at home or outside normal department hours when needed.
• Serve as the department subject matter expert and coach and mentor less experienced team members.
• Provide exceptional customer service and phone etiquette while managing multiple tasks and adapting to changing issues.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Paid time off
• Retirement plans
• Tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED