Financial Clearance Analyst
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.
- 1. Collects, validates and accurately documents patient insurance and benefits information and is fully knowledgeable about all aspects of insurance verification requirements.
- 1.1 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.
- 2. Obtains prior authorizations from third-party payers in accordance with payer requirements.
- 2.1 Utilizes 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.
- 3.1 Enhances the overall patient care experience through efficient work processes and communication of delays, proactively meeting the patient needs.
- 4. Performs other duties as assigned by Supervisor.
- 4.1 Participates in ongoing quality improvement efforts of the department, utilizing good problem solving methods and resourcefulness to address and resolve problems or to refer them to the appropriate person or department for resolution.
High 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).
Two (2) to three (3) years of work experience with insurance authorization/verification of benefits, revenue cycle functions, hospital/physician offices, or related areas required.
CRCS or equivalent certification for Access Professionals required or in process (within an 18 months of hire).
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.
Yale New Haven Health System, through its Yale New Haven, Bridgeport, Greenwich and Northeast Medical Group Delivery Networks, provides comprehensive, cost-effective, advanced patient care characterized by safety and clinical and service quality.
Yale New Haven Health System, in affiliation with Yale School of Medicine and other universities and colleges, educates health professionals and advances clinical care.
In all of its work, YNHHS is committed to the communities it has the privilege of serving.