Financial Clearance Representative III

TriHealth; United States; Remote; USD 35,000 - 50,000; Full time

Job summary

TriHealth is seeking a detail-oriented individual for a work-from-home role focused on verifying patient insurance information. The position involves confirming benefits eligibility, reviewing medical records, and ensuring accurate authorization requests. Ideal candidates will have a high school degree and experience in healthcare customer service, particularly in managed care or patient billing.

Qualifications

• 1-2 years experience in Customer Service Healthcare.
• Understanding of third-party benefits and coverage rules.
• Experience in insurance verification or pre-certification.

Responsibilities

• Verify patient insurance and confirm benefits eligibility.
• Review medical records for authorization requests.
• Calculate and estimate patient liability.

Skills

Medical Terminology

Customer Service

Insurance Vocabulary

Financial Clearance Services

Education

High School Degree

Tools

Automated Patient Account Systems

Online Verification Systems

Job description

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. The purpose of this job is to verify that TriHealth patient insurance information is accurate and up-to-date to ensure payment for services rendered. Additionally, this position requires reviewing medical records to obtain information such as diagnosis, prior treatment, signs and symptoms, medication, and other medical details to submit authorization requests for surgery, testing, or treatment.

This is a Cincinnati-based work-from-home role. Applicants must be located in the Greater Cincinnati area to be considered.

Job Requirements:

• High School Degree with coursework in Medical Terminology or equivalent knowledge
• Knowledge of Medical Terminology and insurance vocabulary and processes
• Understanding of government and non-government third-party benefits and coverage rules
• Awareness of the impact of financial clearance services on revenue cycle operations and financial performance
• 1-2 years experience in Customer Service Healthcare, with a focus on managed care or patient billing
• Experience with automated patient account systems or online verification systems
• Must have at least one year of experience in insurance verification or pre-certification

Job Responsibilities:

Details are not specified in the provided description and may need to be added for clarity.

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:

At TriHealth, we prioritize serving our patients, communities, and team members. All employees are expected to demonstrate the following behaviors:

• Serve: Welcome everyone, acknowledge lost patients/guests, refrain from personal cell phone use in public/patient areas.
• Excel: Address service breakdowns, prioritize waiting patients/guests, improve quality and safety.
• Respect: Respect cultural differences, opinions, and speak positively about colleagues.
• Value: Be punctual, prepared, participate actively, keep the environment clean, and use resources efficiently.
• Engage: Recognize wins, thank team members, show courtesy and compassion.