Financial Clearance Specialist

Trinity Health•Ann Arbor, MI

About The Position

The Financial Clearance Specialist II is responsible for clearing and collecting on pre-service accounts before the date of service. The role obtains and verifies insurance information, validates benefits, determines authorization requirements, and collects pre-service payments. It supports the patient experience and initiates the billing process for hospital services, including complex, high-dollar surgical, observation, inpatient, and ancillary services across multiple facilities and states. The position works across outpatient, elective short procedure/inpatient, and urgent admission verification or scheduling.

Requirements

High school diploma or equivalent.
Two to five years of experience in an area of expertise such as scheduling, financial clearance, or patient access.
At least five years of financial clearance/authorization experience in an acute care setting.
National HFMA CRCR certification required within one year of hire.
Proficiency with Patient Registration/Patient Accounting systems and related software.
Ability to complete the required uninterrupted four-week training.

Nice To Haves

Associate's degree.
Comprehensive scheduling knowledge, mastery of at least three modalities, and insurance verification experience, with three years of scheduling experience in an acute care setting.
Experience with complex facility-based ancillary testing across multiple facilities and states.
Strong knowledge of third-party and government payer billing and reimbursement guidelines, department performance standards, and policies and procedures.

Responsibilities

Perform insurance eligibility and benefit verification through EDI transactions, payer websites, or direct contact with payers, and document findings in the EMR.
Determine the need for pre-certifications, third-party authorizations, and referrals; contact physicians and Case Management/Utilization Review personnel as needed.
Inform patients or guarantors of financial liabilities, calculate amounts owed, provide financial education, and refer patients to financial counseling when appropriate.
Collect copayments, coinsurance, deductibles, deposits, and outstanding balances during pre-registration; document payments and actions in the patient accounting system and provide receipts.
Validate medical necessity for Medicare and non-Medicare cases to support clinical and financial clearance.
Contact scheduling or ancillary department staff to clarify diagnoses, tests, or procedures when needed.
Prepare special reports as directed by the Manager to document Pre-Service unit utilization and patient flow.
Provide relief support to departmental personnel as workload or scheduling requires.
Train new employees when selected and cross-train in various functions to support departmental services.
Perform other duties assigned by the Manager.
Maintain working knowledge of applicable laws, regulations, organizational integrity requirements, standards of conduct, and policies and procedures.