Financial Clearance Specialist

Yale NewHaven Health; New Haven (CT); On-site; USD 52,000 - 76,000; Full time

Job summary

Yale NewHaven Health is seeking a Financial Clearance Specialist to verify insurance benefits for transplant, surgical, chemotherapy, and radiation therapy. You will collaborate with patients and physicians to support the care plan and payer authorizations, ensuring compliance and accuracy across the revenue cycle.

You will use Epic applications to verify coverage, guide patients to available financial assistance, and maintain up-to-date payer requirements while delivering high-quality customer

Qualifications

• High school diploma or GED required with healthcare or business experience preferred.
• Bachelor's degree preferred; professional certifications valued.
• Experience with insurance authorization/verification and revenue cycle functions.
• Certified Medical Assistant (CMS), LPN, or CPC status preferred.
• Strong knowledge of code sets and medical necessity requirements.

Responsibilities

• Verifies patients' insurance and benefits information for transplant, surgical, chemotherapy, and radiation therapy patients.
• Obtains prior authorizations from third-party payers in accordance with payer requirements.
• Utilizes Epic applications from booking to obtain procedure codes as needed.
• Maintains professional approach when communicating with patients, coworkers, and payer representatives.
• Contacts patients to gather demographic and insurance information and updates EMR as necessary.
• Performs other duties to support revenue cycle operations.
• Maintains understanding of third-party payer regulations and medical necessity requirements.

Skills

Strong organizational skills

Excellent verbal and written communic

Strong interpersonal skills

Attention to detail

Multitask

Education

High school diploma or GED

Bachelor's degree preferred

CPC, LPN, Pharmacology license or other medical degree preferred

CRCS or equivalent certification within 18 months of hire

CMS, LPN, or CPC status preferred

Tools

Epic applications

Microsoft Office

Excel

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 Specialist is responsible for ensuring that payers are prepared to reimburse Corporate Business Services (CBS) for scheduled services in accordance with the payer-provider contract. When physicians and clinicians make care decisions, the Financial Clearance Specialist is aware of how a patient's benefits fit into the care plan, and keeps patients and physicians informed of such as they seek of obtain authorizations from payers. This position is responsible for the financial clearance of transplant, surgical, chemotherapy, and radiation therapy patients, including insurance verification, price estimation, and validation of medical necessity for certain services. This position will maintain a proficient understanding of third-party payer regulations and guidelines for these particular service lines, including a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that these patients often require. In addition, will determine benefit and coverage levels and connects patients with financial assistance resources as needed. In all encounters with patients and families, the Financial Clearance Specialist will strive for the highest level of customer service.

EEO/AA/Disability/Veteran

Responsibilities

• 1.Verifies patients' insurance and benefits information for transplant, surgical, chemotherapy, and radiation therapy patients.
• 1.1Exhibits understanding of various insurance carrier options and verifies eligibility as outlined in departmental procedures.
• 2.Obtains prior authorizations from third-party payers in accordance with payer requirements.
• 2.1Utilizes all necessary Epic applications from booking to obtain procedure codes as needed.
• 3.Maintains professional approach at all times when communicating with patients, co-workers, and payer representatives to ensure a positive and professional experience.
• 3.1Contacts patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary.
• 4.Performs other duties as assigned by Supervisor to support revenue cycle operations.
• 4.1Maintains a proficient understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that these patients often require.

Qualifications

EDUCATION

High school graduate or GED required with work in healthcare or business preferred. Bachelor's Degree preferred. CPC, LPN, Pharmacology License or other medical degree or equivalent preferred. CRCS or equivalent certification for Access Professionals required within 18 months of hire. Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status preferred.

EXPERIENCE

Three (3) to four (4) years of work experience with insurance authorization/verification of benefits, revenue cycle functions, hospital/physician offices, or related areas preferred

LICENSURE

Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status preferred.

SPECIAL SKILLS

Strong organizational skills and ability to prioritize tasks. Excellent verbal and written communication skills. Strong interpersonal skills and ability to build rapport with a wide variety of individuals. Advanced working knowledge of code sets required. 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 a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that these patients often require. Demonstrates attention to detail and ability to multitask. Advanced knowledge of Microsoft Office, Word, and Excel.

YNHHS Requisition ID
184050