[Hiring] Financial Clearance Analyst @Yale New Haven Health

Role Description

The Financial Clearance Analyst is responsible for the financial clearance of complex patient authorizations, including:

• Insurance verification
• Price estimation
• Validation of medical necessity for services

Additionally, the role involves coordinating the activities of the patient account from the point of scheduling through account clearance and formulating solutions to respond and resolve non-clinical customer requests, issues, and problems while meeting the changing demands and priorities in a hospital environment.

Works closely with:

• Patients
• Families
• Outside departments
• Third-party payers

Ensures compliance with all authorization and medical necessity guidelines to protect the patient and the Hospital from unnecessary financial loss.

Qualifications

• High school graduate or GED required; work in healthcare or business preferred
• Associate Degree preferred
• CRCS or equivalent certification for Access Professionals required or in process (within 18 months of hire)
• Two (2) to three (3) years of work experience with insurance authorization/verification of benefits, revenue cycle functions, hospital/physician offices, or related areas preferred
• Strong organizational skills and ability to prioritize tasks
• Strong interpersonal skills and ability to build rapport with a wide variety of individuals
• Knowledge of payer reimbursement processes and insurance terminology
• Basic understanding of diagnostic testing and procedure codes (CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS coding, etc.)
• Excellent verbal and written communication skills including the ability to communicate with physician providers
• Intermediate working knowledge/understanding of medical terminology and disease process
• Expert knowledge of Microsoft Office, Word, and Excel

Requirements

• Collects, validates, and accurately documents patient insurance and benefits information
• Utilizes the On-line Eligibility system and/or other means (i.e. telephone, fax or various third-party payer websites) to obtain insurance benefits
• Demonstrates a thorough understanding of Epic, Outlook, and On-line Eligibility system
• Completes all pre-certification notices prior to admission
• Alerts the clinician involved in the patient's care when there are issues with referrals or complications with insurance coverage
• Obtains all UB-04 information and ensures compliance with health care regulations
• Possesses good working knowledge of medical necessity rules
• Obtains prior authorizations from third-party payers
• Utilizes all necessary Epic applications from booking to obtain procedure codes
• Reads and comprehends the medical record to help identify pertinent information
• Provides information to third parties to determine benefits and obtains necessary approvals
• Contributes to the financial vitality of the organization
• Educates patients and clinicians about the authorization process
• Ensures that all subsequent follow-up activity is established and adheres to a timely schedule
• Works with business office staff to understand/trend efforts for authorization-related denials
• Maintains accurate records of authorizations with the EMR and payer sites
• Maintains a professional approach at all times
• Enhances the overall patient care experience through efficient work processes
• Collaborates with departments and co-workers to enhance physician and patient satisfaction
• Contacts patients as needed to gather demographic and insurance information
• Informs the patient whether the authorization for the referral has not been approved
• Calculates and provides patient liability estimate
• Requests pre-service payment for patient liability and/or arranges payment plans
• Identifies events where Service Recovery is appropriate
• Participates in ongoing quality improvement efforts of the department
• Identifies and recommends opportunities to improve Patient Access or Financial Clearance activities
• Keeps abreast of changing federal, state, and insurance regulations
• Presents facts in a logical pattern and completes summaries for upper management
• Exhibits a positive attitude in interactions with co-workers
• Actively participates in all staff meetings, seminars, training sessions, and work groups
• Maintains CRCS or equivalent certification for Access Professionals

Company Description