Financial Clearance Analyst

Yale New Haven Health; Oregon; Hybrid; USD 52,000 - 78,000; Full time

Job summary

Yale New Haven Health is seeking a Financial Clearance Analyst to verify insurance benefits, assess medical necessity, and coordinate patient accounts from scheduling through clearance. The role requires strong knowledge of payer rules, CMS guidelines, and Epic applications.

You will input accurate insurance data, obtain pre-authorizations, and communicate coverage details to patients and care teams. Experience in health care revenue cycle and Excel proficiency are preferred.

Qualifications

• Must have high school diploma or GED; associate degree preferred.
• CRCS or equivalent certification for Access Professionals required or in process (within 18 months).
• Experience with insurance authorization/verification, revenue cycle, and hospital/physician offices preferred.

Responsibilities

• Handle financial clearance of complex patient authorizations, including insurance verification and price estimation.
• Coordinate patient account activities from scheduling to clearance.
• Identify and resolve non-clinical issues impacting payment and authorization timing.
• Communicate care and coverage details to patients, clinicians, and payers; ensure compliance with payer guidelines.

Skills

Organizational skills

Interpersonal skills

Payer reimbursement processes

Insurance terminology

Verbal and written communication

Medical terminology knowledge

Microsoft Office (Excel/Word)

Education

High school diploma or GED

Associate degree (preferred)

CRCS or equivalent Access Professionals certification

Tools

Epic

Outlook

On-line Eligibility system

Excel

Word

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/VeteranResponsibilities 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. Demonstrates a thorough understanding of Epic, Outlook, and On-line Eligibility system in order to determine insurance eligibility, initial pre-certifications, and approvals. Completes all pre-certification notices prior to admission and initiates the notification process to the insurance company within 24-48 hours of emergency admissions escalating to management as needed when unresolved problems occur. 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 that govern hospital billing. Possesses good working knowledge of medical necessity rules to determine if the scheduled procedures is in accordance with Centers for Medicare &Medicaid Services (CMS) or other payer standards, and communicates coverage/eligibility information to patients. 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. Reads and comprehends the medical record to help identify pertinent information to obtain necessary authorization. Must be able to communicate complex clinical information to necessary parties. Provides information to the third parties to determine benefits and obtains the necessary approvals and authorizations to ensure accounts can be billed and payment received. Possesses a working knowledge of hospital services, diagnostic testing and code sets (CPT, HCPCS, ICD-10-CM/PCS coding, etc.). Contributes to the financial vitality of the organization by thoroughly understanding key operational dependencies (insurance eligibility, referral, authorizations, etc.) and verifies eligibility as outlined in departmental procedures. Educates patients and clinicians about the authorization process as well as medical necessity rules, local coverage determination policies and any other payer-specific guidelines. 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 resulting in reduced denials. Maintains accurate records of authorizations with the EMR and payer sites.

Qualifications

EDUCATIONHigh 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).EXPERIENCETwo (2) to three (3) years of work experience with insurance authorization/verification of benefits, revenue cycle functions, hospital/physician offices, or related areas preferred.LICENSURECRCS 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 ID193677