Financial Clearance Representative III

Role Description

At TriHealth, our Financial Clearance Representatives play a critical role in ensuring every patient begins their care journey with clarity, compassion, and confidence. You are at the front line of financial advocacy—helping patients understand coverage, removing barriers to care, and contributing directly to a seamless, trusted healthcare experience.

Job Overview:

• This position is responsible for verifying patient insurance, confirming benefits eligibility, performing authorization and pre-certification, calculating and estimating patient liability, and/or notification as required by third party coverage providers.
• Purpose of this job is to verify that TriHealth patient insurance information is accurate and up to date so payment will be received for services rendered.
• This position requires the knowledge to review medical records obtaining information such as diagnosis, prior treatment, signs and symptoms, medication, and other medical information to submit requests for authorizations for surgery, testing, or treatment.

Qualifications

• High School Degree in Medical terminology course or equivalent knowledge
• Knowledge of Medical Terminology
• Insurance vocabulary and processes
• Government and Non-government third party benefits and coverage rules
• Understanding of the impact financial clearance services has on revenue cycle operations and financial performance
• 1-2 years experience in Customer Service Healthcare
• Dedication to treating both internal and external constituents as clients and customers
• Maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality
• Background in managed care or patient billing
• 1-2 years experience in Technical Healthcare
• Must have one year experience in insurance verification or precertification experience
• Experience with automated patient account system or online verification systems

Requirements

• Location: Work from home
• Schedule: 8:30 AM- 5:00 PM, M-F

Benefits

• Competitive shift differentials
• Opportunities for professional growth
• Comprehensive benefits package that may include:
• Medical
• Dental
• Vision
• Paid time off
• Retirement savings plans
• Tuition reimbursement
• PRN positions not eligible for TriHealth benefits

Working Conditions

• Climbing - Rarely
• Concentrating - Consistently
• Continuous Learning - Frequently
• Hearing: Conversation - Consistently
• Hearing: Other Sounds - Rarely
• Interpersonal Communication - Consistently
• Kneeling - Rarely
• Lifting <10 Lbs - Rarely
• Lifting 50+ Lbs - Rarely
• Lifting 11-50 Lbs - Rarely
• Pulling - Rarely
• Pushing - Rarely
• Reaching - Occasionally
• Reading - Consistently
• Sitting - Frequently
• Standing - Occasionally
• Stooping - Occasionally
• Talking - Consistently
• Thinking/Reasoning - Consistently
• Use of Hands - Consistently
• Color Vision - Rarely
• Visual Acuity: Far - Consistently
• Visual Acuity: Near - Consistently
• Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

• Serve: ALWAYS…
• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas
• Excel: ALWAYS…
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service
• Respect: ALWAYS…
• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone’s opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.
• Value: ALWAYS…
• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
• Engage: ALWAYS…
• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members, and the community.