Financial Clearance Analyst

Yale New Haven Health; New Haven (CT); On-site; USD 55,000 - 75,000; Full time

Job summary

Yale New Haven Health in Connecticut is seeking a Financial Clearance Analyst to manage the financial clearance of complex patient authorizations, verify insurance, estimate prices, and validate medical necessity for services.

You will coordinate patient accounts from scheduling through clearance, interfacing with patients, families, departments and payers to maintain compliance and protect the hospital from financial risk.

Qualifications

• High school graduate or GED with healthcare or business preferred.
• CRCS or equivalent certification for Access Professionals required or in process (within an 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 and interpersonal skills; ability to build rapport with a wide variety of individuals.
• Knowledge of payer reimbursement processes and medical terminology.
• Basic understanding of CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS coding; excellent verbal and written communication.

Responsibilities

• Collects, validates and documents patient insurance and benefits information; knowledgeable about all insurance verification requirements.
• Uses On-line Eligibility system and/or other means to obtain benefits and inputs information into Epic; alerts staff of issues as needed.
• Obtains prior authorizations from third-party payers per payer requirements; uses Epic applications.
• Maintains a professional approach in communications with patients, coworkers and payers; supports timely information flow and service quality.
• Participates in ongoing quality improvement efforts within the department; refers issues to appropriate personnel.
• Performs other duties as assigned by Supervisor.

Skills

Insurance verification

Prior authorizations

Epic system

Excel

Communication skills

Education

High school diploma or GED

Associate degree

CRCS certification

Tools

Epic

Microsoft Office

Job description

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Financial Clearance Analyst is responsible for the financial clearance of complex patient authorizations, including insurance verification, price estimation, and validation of medical necessity for services. In addition, is accountable for coordinating the activities of the patient account from the point of scheduling through account clearance. Formulates 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 the patients, families, outside departments and third party payers to ensure compliance to all authorization and medical necessity guidelines in order to protect the patient and the Hospital from unnecessary financial loss.

EEO/AA/Disability/Veteran

Responsibilities

• Collects, validates and accurately documents patient insurance and benefits information and is fully knowledgeable about all aspects of insurance verification requirements.
  • Utilizes the On-line Eligibility system and/or other means (i.e. telephone, fax or various third party payer website) to obtain insurance benefits and makes sure insurance verification information is accurate and inputs the information into Epic. When necessary, alerts the appropriate staff of insufficient and/or termination of benefits.
• Obtains prior authorizations from third-party payers in accordance with payer requirements.
  • Utilizes all necessary Epic applications from booking to obtain procedure codes as needed.
• Maintains professional approach at all times when communicating with patients, co-workers, and payer representatives to ensure a positive and professional experience.
  • Enhances the overall patient care experience through efficient work processes and communication of delays, proactively meeting the patient needs.
• Performs other duties as assigned by Supervisor.
  • Participates in ongoing quality improvement efforts of the department, utilizing good problem solving methods and resourcefulness to address and resolve problems or to refer them to the appropriate person or department for resolution.

Qualifications

EDUCATION

High school graduate or GED required with work in healthcare or business preferred. Associate Degree preferred. CRCS or equivalent certification for Access Professionals required or in process (within an 18 months of hire).

EXPERIENCE

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.

LICENSURE

CRCS or equivalent certification for Access Professionals required or in process (within an 18 months of hire).

SPECIAL SKILLS

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.

YNHHS Requisition ID

184170