Financial Clearance Representative III

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. Additionally, this position requires the knowledge to review medical records obtaining information such as diagnosis, prior treatment, sign and symptoms, medication and other medical information to submit requests for authorizations for surgery, testing or treatment. 


Job Requirements:


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 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 Technical Healthcare 

Must have one year experience in insurance verification or precertification experience 

Experience with automated patient account system or online verification systems


Job Responsibilities:


Other job-related information:


Working Conditions:


Climbing - Rarely

Concentrating - Consistently

Continous 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

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: 


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