Financial Clearance Representative III

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 Incentives & Benefits: 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 Minimum 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 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 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