Financial Clearance/Referral Analyst - Yale New Haven Health

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 /Referral Analyst is responsible for the financial clearance of complex patient authorizations and referrals, 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 referral 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/referral and medical necessity guidelines to protect the patient and the Hospital from unnecessary financial loss.

EEO/AA/Disability/VeteranResponsibilities:

• 1. Collects, validates, and accurately documents patient insurance and benefits information and is fully knowledgeable about all aspects of authorization and referral 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 referral information is accurate and inputs the information into Epic.
• 2. Obtains prior authorizations and referral requirements from third-party payers in accordance with payer requirements.
• 2.1 Utilizes all necessary Epic applications from appointments/admissions to obtain procedure codes as needed.
• 3. Always maintains professional approach 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.

Qualifications:

EDUCATION

High School degree or required with work in healthcare or business preferred. Associate Degree preferred.

EXPERIENCE

Two (2) to three (3) years of work experience with insurance authorization/referral verification of benefits, revenue cycle functions, hospital/physician offices, or related areas preferred.

SPECIAL SKILLS

Strong organizational skills and ability to prioritize tasks. Strong people skills and ability to build rapport with a wide variety of individuals. Knowledge of payer reimbursement processes and insurance terminology. Basic understanding of physician/health system services, 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