Financial Clearance Representative III

TriHealth; Cincinnati, Northern (OH, KY); Hybrid; USD 38,000 - 54,000; Full time

Job summary

TriHealth is seeking a Financial Clearance Representative who verifies patient insurance, confirms benefits, and processes authorizations to ensure accurate coverage and timely payment for services. The role involves reviewing medical records to support requests for surgery, tests, and treatments.

Responsibilities include calculating patient liability, communicating estimates to patients, and navigating third-party coverage rules while maintaining compassionate, patient-centered service.

Qualifications

• Requires a High School Diploma or equivalent with medical terminology knowledge.
• 1 year of insurance verification or precertification experience is required.
• Experience with automated patient accounts systems or online verification tools is preferred.

Responsibilities

• Verify patient insurance and confirm benefits eligibility.
• Perform authorizations and pre-certifications as required by third-party payors.
• Calculate and estimate patient liability and communicate it to patients.
• Review medical records to obtain diagnosis, treatments, signs/symptoms, medications for authorization requests.

Skills

Medical terminology

Insurance vocabulary

Precertification

Customer service

Managed care

Billing knowledge

Verification systems

Education

High School Diploma or equivalent

Job 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.

Location: Work from home

Schedule: 8:30 AM- 5:00 PM, M-F

We offer competitive shift differentials, opportunities for professional growth, and a comprehensive benefits package that may include medical, dental, vision, paid time off, retirement savings plans, and tuition reimbursement.

*PRN positions not eligible for TriHealth benefits

• 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 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.

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

Visual Acuity: Far - Consistently

Visual Acuity: Near - Consistently

Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

• 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
• 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 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 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.
• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community

Job Info

• Job Category Administrative
• Job Schedule Full time
• Locations 4452 Eastgate Blvd, Cincinnati, OH, 45245, US