Financial Clearance Analyst

Yale New Haven Health • New Haven, CT

7d

About The Position

The Financial Clearance Analyst is responsible for financial clearance of complex patient authorizations, including insurance verification, price estimation, and validation of medical necessity for services. The role coordinates patient account activities from scheduling through account clearance and develops solutions to resolve non-clinical customer requests, issues, and problems while adapting to changing demands and priorities in a hospital environment. The analyst works with patients, families, other departments, and third-party payers to ensure compliance with authorization and medical necessity guidelines and help protect patients and the hospital from unnecessary financial loss.

Employees are expected to understand and share the YNHHS Vision, support its Mission, and demonstrate its Values of integrity, patient-centeredness, respect, accountability, and compassion in their work.

Requirements

• High school diploma or GED required.
• CRCS or equivalent certification for Access Professionals required or must be in process within 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, including CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS.
• Excellent verbal and written communication skills, including the ability to communicate with physician providers.
• Intermediate working knowledge and understanding of medical terminology and disease processes.
• Expert knowledge of Microsoft Office, Word, and Excel.

Nice To Haves

• Healthcare or business work experience.
• Associate degree.
• Two to three years of experience with insurance authorization or benefits verification, revenue cycle functions, hospital or physician offices, or related areas.

Responsibilities

• Collect, validate, and accurately document patient insurance and benefits information; maintain knowledge of insurance verification requirements.
• Use online eligibility systems and other methods, such as telephone, fax, and third-party payer websites, to obtain benefits information; enter accurate information into Epic and alert appropriate staff to insufficient or terminated benefits when necessary.
• Obtain prior authorizations from third-party payers in accordance with payer requirements.
• Use necessary Epic applications from booking to obtain procedure codes as needed.
• Communicate professionally with patients, coworkers, and payer representatives.
• Support a positive patient care experience through efficient work processes and communication about delays, proactively addressing patient needs.
• Participate in departmental quality improvement efforts and use problem-solving methods and resourcefulness to resolve issues or refer them to the appropriate person or department.
• Perform other duties as assigned by the supervisor.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED