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Patient Financial Services Coordinator
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 - are essential in guiding 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 alignment with payer-provider agreements. This position requires a thorough understanding of how a patient's insurance benefits integrate into their care plan, and it is vital to keep both patients and healthcare providers informed while obtaining necessary authorizations from payers. Responsibilities include managing the financial clearance process for patients undergoing transplant, surgical, chemotherapy, and radiation therapy procedures. This encompasses verifying insurance coverage, estimating costs, and confirming medical necessity for specific services.
The role demands a comprehensive knowledge of third-party payer regulations and guidelines relevant to these service lines, as well as an understanding of medical necessity for pharmaceuticals and ongoing services that patients may require. Additionally, the Financial Clearance Specialist will assess benefit and coverage levels and connect patients with financial assistance resources when necessary. Exceptional customer service is a priority in all interactions with patients and their families.
Key Responsibilities
1. Verify patients' insurance and benefits information for transplant, surgical, chemotherapy, and radiation therapy cases. 2. Demonstrate knowledge of various insurance options and confirm eligibility as per departmental protocols. 3. Secure prior authorizations from third-party payers following their specific 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 foster a positive experience. 6. Contact patients as needed to collect demographic and insurance details, updating the EMR accordingly. 7. Perform additional duties as assigned by the Supervisor to enhance revenue cycle operations. 8. Maintain a proficient understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy services, including medical necessity for pharmaceuticals and recurring services. Qualifications
EDUCATION: High school diploma or GED is required; experience in healthcare or business is preferred. A Bachelor's Degree is desirable. Certifications such as CPC, LPN, or other medical qualifications are preferred. CRCS or equivalent certification for Access Professionals is required within 18 months of employment.
EXPERIENCE: A minimum of three (3) to four (4) years of experience in insurance authorization, benefits verification, revenue cycle operations, or related fields is preferred.
LICENSURE: Preferred certifications include Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC).
SPECIAL SKILLS: Strong organizational skills with the ability to prioritize tasks effectively. Excellent verbal and written communication skills. Strong interpersonal abilities to build rapport with diverse individuals. Advanced knowledge of coding systems is required. Basic understanding of diagnostic testing and procedure codes (CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS) is essential. Attention to detail and multitasking capabilities are crucial. Proficiency in Microsoft Office, including Word and Excel, is required.
