Financial Clearance Specialist

Yale New Haven Health Services Corp.; New Haven (CT); Vor Ort; USD 40.000 - 60.000; Vollzeit

Zusammenfassung

Yale New Haven Health Services Corp. seeks an Insurance Authorization/Verification Specialist to support our revenue cycle team. You will verify patients' insurance, obtain prior authorizations, and ensure accurate demographic and billing information within the EMR.

The role requires knowledge of coding basics, familiarity with Epic systems, and excellent organizational and communication skills to support transplant, surgical, chemotherapy, and radiation therapy services.

Qualifikationen

• Requires experience verifying insurance benefits and obtaining authorizations.
• Familiarity with CPT/ICD coding basics is a plus.
• Strong communication and organizational skills essential.

Aufgaben

• Verify patients' insurance and benefits for transplant, surgical, chemotherapy, and radiation therapy.
• Obtain prior authorizations from third-party payers per requirements.
• Update patient information in the EMR and coordinate with payer representatives.
• Maintain understanding of third-party payer regulations and medical necessity for services.

Kenntnisse

Insurance verification

Prior authorizations

EMR navigation (Epic)

Communication skills

Ausbildung

High school diploma or GED

Bachelor's degree preferred

CPC/LPN/CMS or related certification preferred

Tools

Epic

Microsoft Office

Jobbeschreibung

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.

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.