Pre-Authorization & Financial Clearance Specialist

Bristol Hospital Group; Bristol (CT); On-site; USD 26,000 - 55,000; Full time

Job summary

Bristol Health is seeking a Financial Clearance Analyst at our Bristol, CT facility to verify authorizations, validate medical necessity, and coordinate with providers for pre-certifications. You will help ensure timely approvals and accurate billing readiness across departments.

The role emphasizes payer requirements, patient communication, and adherence to regulatory standards, contributing to smooth revenue cycle operations and high-quality patient care.

Qualifications

• Bachelor's degree plus 1 year revenue cycle experience or Associate degree plus 2 years revenue cycle experience or High School Diploma plus 5 years revenue cycle experience.
• Experience with payer portals and requirements preferred.
• Familiarity with medical and insurance terminology; knowledge of payer contracts, regulations and guidelines.

Responsibilities

• Handle authorization process and obtain pre-certification approvals prior to service.
• Submit pre-authorization requests and follow up with payer to ensure timely approvals.
• Maintain accurate records and reports of pre-certifications, approvals, and denials.
• Work assigned worklists and submit authorization information according to payer requirements.
• Follow up on authorization requests and coordinate with practices and departments according to policies.
• Collaborate with revenue cycle team and participate in monthly meetings to review payment and denial trends.
• Coordinate with provider practices and hospital departments to ensure timely scheduling of patient procedures.
• Respond to patient and insurance inquiries and provide Good Faith Estimates when required.
• Perform post service reconciliations and denial follow up tasks.
• Act as a back-up to the Financial Counselor team, supporting Notice of Admission and Financial activities.
• Adhere to HIPAA and state/federal regulations; adhere to applicable policies and procedures.
• Other duties as assigned

Skills

Quality and integrity

Patient-centric service

Teamwork and collaboration

Communication skills

Problem solving

Payer requirements literacy

Independent work

Customer service excellence

Multi-tasking

Organizational skills

Education

Bachelor's degree

Associate degree

High School Diploma

Job description

Bristol Health is seeking a Financial Clearance Analyst at our Bristol, CT facility to verify authorizations, validate medical necessity, and coordinate with providers for pre-certifications. You will help ensure timely approvals and accurate billing readiness across departments.

The role emphasizes payer requirements, patient communication, and adherence to regulatory standards, contributing to smooth revenue cycle operations and high-quality patient care.