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Healthcare Financial Clearance Analyst
2 months ago
At Yale New Haven Health, we believe that every team member should embody our Vision, support our Mission, and uphold our Values. Our core values - integrity, patient-centered care, respect, accountability, and compassion - guide our daily actions as professionals.
The Financial Clearance Specialist plays a crucial role in ensuring that payers are ready to reimburse Corporate Business Services (CBS) for scheduled medical services in line with the payer-provider agreements. This position is essential in helping physicians and clinicians make informed care decisions by understanding how a patient's insurance benefits align with their treatment plans. The specialist is responsible for the financial clearance of patients undergoing transplant, surgical, chemotherapy, and radiation therapy, which includes verifying insurance, estimating costs, and confirming medical necessity for specific services.
This role requires a comprehensive understanding of third-party payer regulations and guidelines related to these service lines, as well as a solid grasp of medical necessity criteria for the pharmaceuticals and ongoing services frequently needed by these patients. Additionally, the specialist will assess benefit and coverage levels and connect patients with financial assistance resources when necessary. Throughout all interactions with patients and their families, the Financial Clearance Specialist is committed to delivering exceptional customer service.
Responsibilities
1. Verify patients' insurance and benefits information for those undergoing transplant, surgical, chemotherapy, and radiation therapy. 2. Demonstrate knowledge of various insurance carrier options and confirm eligibility as per departmental protocols. 3. Secure prior authorizations from third-party payers in compliance with their requirements. 4. Utilize necessary Epic applications to obtain procedure codes as required. 5. Maintain a professional demeanor in all communications with patients, colleagues, and payer representatives to ensure a positive experience. 6. Contact patients as needed to collect demographic and insurance details, updating patient information in the EMR as necessary. 7. Perform additional duties as assigned by the Supervisor to support revenue cycle operations. 8. Maintain a thorough understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including medical necessity requirements for pharmaceuticals and recurring services. Qualifications
EDUCATION
A high school diploma or GED is required, with a preference for experience in healthcare or business. A Bachelor's Degree is preferred. Certifications such as CPC, LPN, or a Pharmacology License are advantageous. CRCS or equivalent certification for Access Professionals is required within 18 months of hire. Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status is preferred.
EXPERIENCE
Three to four years of experience in insurance authorization/verification of benefits, revenue cycle functions, or related fields is preferred.
LICENSURE
Preference for Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status.
SPECIAL SKILLS
Strong organizational abilities and task prioritization skills. Excellent verbal and written communication skills. Strong interpersonal skills with the ability to establish rapport with diverse individuals. Advanced knowledge of required code sets. Basic understanding of diagnostic testing and procedure codes (CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS coding, etc.). Maintains a proficient understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including medical necessity requirements for pharmaceuticals and recurring services. Demonstrates attention to detail and the ability to multitask. Proficient in Microsoft Office, including Word and Excel.
