Financial Clearance Specialist

Yale New Haven Health • New Haven, CT

4d

About The Position

The Financial Clearance Specialist ensures that payers are prepared to reimburse Corporate Business Services (CBS) for scheduled services in accordance with payer-provider contracts. The specialist considers how patients’ benefits fit into their care plans and keeps patients and physicians informed while obtaining payer authorizations. The position handles financial clearance for transplant, surgical, chemotherapy, and radiation therapy patients, including insurance verification, price estimation, and validation of medical necessity for certain services. It requires a proficient understanding of third-party payer regulations and guidelines for these service lines, including medical necessity requirements for pharmaceuticals and recurring services. The specialist determines benefit and coverage levels, connects patients with financial assistance resources as needed, and strives to provide patients and families with the highest level of customer service.

Requirements

• High school diploma or GED.
• CRCS or equivalent certification for Access Professionals required within 18 months of hire.
• 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.
• Basic understanding of diagnostic testing and procedure codes, including CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS.
• Proficient understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including medical necessity requirements for pharmaceuticals and recurring services.
• Attention to detail and ability to multitask.
• Advanced knowledge of Microsoft Office, Word, and Excel.

Nice To Haves

• Healthcare or business work experience.
• Bachelor's degree.
• CPC, LPN, Pharmacology License, other medical degree, or equivalent.
• Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status.
• Three to four years of experience with insurance authorization or benefits verification, revenue cycle functions, hospital or physician offices, or related areas.

Responsibilities

• Verify insurance and benefits information for transplant, surgical, chemotherapy, and radiation therapy patients, including checking eligibility according to departmental procedures.
• 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.
• Contact patients to gather demographic and insurance information and update patient information in the EMR as necessary.
• Perform other duties assigned by the Supervisor to support revenue cycle operations.
• Maintain an understanding of payer regulations and guidelines for the relevant service lines, including medical necessity requirements for pharmaceuticals and recurring services.

What This Job Offers

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