Financial Clearance Specialist

Yale New Haven Health Services Corp.; New Haven, Northern (CT, KY); Hybrid; USD 54,000 - 72,000; Full time

Job summary

Yale New Haven Health Services Corp. is seeking a Financial Clearance Specialist to verify insurance, determine coverage, and obtain authorizations for transplant, surgical, chemotherapy, and radiation services.

You will act as a liaison between patients, physicians, and payers, ensuring accurate benefit navigation and compliant billing. The role requires strong organizational skills, attention to detail, and proficiency with Epic and standard office software.

Qualifications

• High school diploma or GED; healthcare/business preferred.
• 3–4 years of experience with insurance authorization/verification.
• Certified Medical Assistant (CMS), LPN, or CPC status preferred.

Responsibilities

• Verify patients' insurance and benefits for transplant, surgical, chemotherapy, and radiation therapy patients.
• Obtain prior authorizations from third-party payers per requirements.
• Maintain professional communication with patients, co-workers, and payers; update EMR as needed.
• Support revenue cycle operations as assigned by Supervisor.

Skills

Insurance verification

Customer service

Organization

Communication

Code sets knowledge

Microsoft Office

Education

High school diploma or GED

Bachelor's degree preferred

CPC

LPN

Pharmacology license

CRCS

CMS

Tools

Epic

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.