Financial Clearance Specialist

MI_SJMHS Trinity Health - Michigan; Ann Arbor (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

Trinity Health Corp. in Michigan is seeking a Financial Clearance Specialist II to manage pre-service accounts' financial clearance and collections prior to service.

You will verify insurance, benefits, authorizations, and coordinate with multiple facilities for complex surgical and in-house services. The role requires 5+ years in financial clearance/authorization in acute care, strong knowledge of payer billing, and proficiency with patient registration/accounting systems.

Qualifications

• Minimum five (5) years of financial clearance/authorization experience in an acute care setting.
• National certification in HFMA CRCR required within one (1) year of hire.
• Associate's degree in healthcare administration or related field preferred.

Responsibilities

• Performs insurance eligibility/benefit verification using a variety of mechanisms and documents information in the EMR system.
• Determines need for appropriate service authorizations and coordinates with physicians and care teams.
• Informs patient/guarantor of liabilities and collects patient balances at pre-registration.
• Documents payments/actions in patient accounting systems and provides receipts.
• Validates medical necessity for Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Supports scheduling and ancillary departments for case clarification when needed.

Skills

Insurance verification

Benefit validation

Pre-service clearance

Patient accounting systems

Eligibility/authorization experience

Education

High School Diploma or equivalent

Associate's degree preferred

Tools

EMR systems

EDI transactions

Payer portals

Job description

Employment Type: Full time Shift: Day Shift Description

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. 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 any services provided by the hospital. 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 or subject 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.*

Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.