Financial Clearance Specialist

Description The Financial Clearance Specialist II is responsible for all pre‑service accounts’ financial clearance and collection prior to the date of service. The role obtains and verifies accurate insurance information, benefits, authorizations, and preservice collections, and initiates the billing process for services provided by the hospital. It handles complex, high‑dollar services—including surgical, observation, and in‑house cases—across multiple facilities and states, working in outpatient verification, elective short procedure / inpatient verification, and urgent admission verification or scheduling. Minimum of five (5) years of financial clearance/authorization experience in an acute care setting is required. Employment Type Full time Shift Day Shift Minimum Qualifications High School Diploma or equivalent. Two to Five years of experience in scheduling, financial clearance, or patient access. National certification in HFMA CRCR required within one year of hire. Proficiency in Patient Registration/Patient Accounting systems and related software. Additional Qualifications Associate’s degree is preferred. Comprehensive knowledge of scheduling with mastery in at least three modalities and insurance verification processes, with three years of scheduling experience in an acute care setting. Experience with complex facility‑based ancillary testing across multiple facilities or states. Strong knowledge of third‑party and government payer billing and reimbursement guidelines, as well as departmental performance standards, policies and procedures. Essential Functions Performs insurance eligibility/benefit verification using EDI transactions, payer web access, and phone calls, documenting within the EMR system. Determines need for service authorizations and contacts physicians and Case Management/Utilization Review personnel as necessary. Informs patients and guarantors of liabilities, collects pre‑registration payments, calculates patient liabilities, and provides financial education, including referrals to counseling. Validates medical necessity of Medicare and non‑Medicare cases to ensure clinical and financial clearance. Coordinates with scheduling and ancillary department staff to clarify diagnoses or procedures. Prepares special reports as directed by the Manager, such as patient service time or call volume. Provides relief support or training as needed, and cross‑trains in various functions to aid departmental delivery. Maintains knowledge of applicable federal, state, and local laws, regulations, and Trinity Health policies. Physical & Mental Requirements & Working Conditions Exposure to unpleasant conditions, fumes, odors, dusts, mists, gases, biohazards, mechanical, electrical, burns, chemicals, radiation, sharp objects, etc. Occasional. Exposure to noise, infectious waste, diseases, and conditions. Occasional. Exposure to interruptions, shifting priorities, stressful situations. Frequent. Ability to follow tasks through to completion, understand complex ideas, remember multiple tasks, and work on concurrent projects. Continuous. Ability to read small print, hear sounds and speech patterns, give/receive instructions in person or via phone/computer. Continuous. Perform manual dexterity activities. Frequent. Ability to climb, kneel, crouch, or operate foot controls. Occasional. Use a computer or other technology. Continuous. Sit with ability to vary/adjust physical position. Continuous. Comply with Trinity Health’s Code of Conduct, policies, procedures, and guidelines. Continuous. Ability to assist in emergencies. Occasional. Equal Employment Opportunity Statement 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. #J-18808-Ljbffr