Financial Clearance Specialist

Financial Clearance Specialist II

The Financial Clearance Specialist II is 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 services provided by the hospital.

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.

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

Direct Healthcare Services / Indirect Healthcare / Support Services:

Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional

Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional

Exposure to noise, infectious waste, diseases & conditions. Occasional

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

Perform manual dexterity activities & / or grasping / handling. Frequent Ability to climb, kneel, crouch & / or operate foot controls. Occasional

Use a computer / other technology. Continuous

Sit with the ability to vary / adjust physical position or activity. Continuous

Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Continuous

Ability to provide assistance in the event of an emergency. Occasional

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.

*The required training is uninterrupted 4 weeks.