Financial Clearance Specialist

Employment Type:

Shift:

Description:

Remote position.

Weekends as required.

Responsible for complex, high-dollar services including surgical, observation and in-house services working in multiple areas of verification including outpatient verification, elective short procedure / inpatient verification, & urgent admission verification or scheduling.

Responsible for all pre-service accounts' financial clearance and collection prior to the date of service.
Obtains and verifies accurate insurance information, benefit validation, authorization, and preservice collections.
Begins the overall patient experience and initiates the billing process for any services provided by the hospital.

Experienced in complex facility based ancillary testing across multiple facilities/states.

Experienced in processing financial clearance for complex services including surgical services, observation, and in-house cases.
Minimum of five (5) years of financial clearance / authorization experience in an acute care setting.

Minimum Qualifications
High School Diploma or equivalent.
Two (2) to Five (5) years experience in area of expertise such as scheduling, financial clearance, or patient access.
National certification in HFMA CRCR required within one (1) year of hire.
Must be proficient in the use of Patient Registration/Patient Accounting systems and related software systems.

Additional Qualifications
Associate's degree is preferred.
Comprehensive knowledge of scheduling with mastery in at least three (3) or more modalities and insurance verification processes with three (3) years 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 and reimbursement guidelines as well as department performance standards and policies and procedures.

Physical & Mental Requirements & Working Conditions

• Exposure to interruptions, shifting priorities & stressful situations. Frequent
• Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Continuous
• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Continuous

KEY: Average Workday Activity: Occasional (1% - 33%), Frequent (34% - 66%), Continuous (67% -100%)

Essential Functions:

Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (primarily EDI transactions and payer web access, and in some cases by calling payers directly) and documenting information within the EMR system.  Outcomes of the insurance eligibility/benefit verification activity will determine next steps (designation as a Self-Pay account, referral to financial counseling, etc.). Determines need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and will contact the physician and Case Management/Utilization Review personnel, as necessary. 

Informs patient/guarantor of their liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.  Calculates patient liabilities and provides financial education, referring the patient to financial counseling, as required.   Documents payments/actions in the patient accounting system and provides the patient with a payment receipt in the collection of funds. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.  Contacts scheduling and/or ancillary department staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s). May prepare special reports as directed by the Manager to document utilization of the Pre-Service unit's services and patient flow (e.g., patient service time, call volume, etc.). May serve as relief support, if the work schedule or work-load demands assistance to departmental personnel.  May also be chosen to serve as a resource to train new employees.  Cross- training in various functions is expected to assist in the smooth delivery of departmental services.  Other duties as needed and assigned by the Manager. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.