Smilow Cancer Hospital ยท 1 month ago
Financial Clearance Analyst
New Haven, CT
Full-time
Onsite
Entry, Mid Level
2+ years expSmilow Cancer Hospital is dedicated to providing exceptional patient care guided by their core values. The Financial Clearance Analyst is responsible for the financial clearance of complex patient authorizations, ensuring compliance with insurance verification and medical necessity guidelines while coordinating patient account activities.
Hospital & Health Care
Responsibilities
Collects, validates and accurately documents patient insurance and benefits information and is fully knowledgeable about all aspects of insurance verification requirements
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
Demonstrates a thorough understanding of Epic, Outlook, and On-line Eligibility system in order to determine insurance eligibility, initial pre-certifications, and approvals
Completes all pre-certification notices prior to admission and initiates the notification process to the insurance company within 24-48 hours of emergency admissions escalating to management as needed when unresolved problems occur
Alerts the clinician involved in the patient's care when there are issues with referrals or complications with insurance coverage
Obtains all UB-04 information and ensures compliance with health care regulations that govern hospital billing
Possesses good working knowledge of medical necessity rules to determine if the scheduled procedures is in accordance with Centers for Medicare & Medicaid Services (CMS) or other payer standards, and communicates coverage/eligibility information to patients
Obtains prior authorizations from third-party payers in accordance with payer requirements
Utilizes all necessary Epic applications from booking to obtain procedure codes as needed
Reads and comprehends the medical record to help identify pertinent information to obtain necessary authorization. Must be able to communicate complex clinical information to necessary parties
Provides information to the third parties to determine benefits and obtains the necessary approvals and authorizations to ensure accounts can be billed and payment received
Possesses a working knowledge of hospital services, diagnostic testing and code sets (CPT, HCPCS, ICD-10-CM/PCS coding, etc.)
Contributes to the financial vitality of the organization by thoroughly understanding key operational dependencies (insurance eligibility, referral, authorizations, etc.) and verifies eligibility as outlined in departmental procedures
Educates patients and clinicians about the authorization process as well as medical necessity rules, local coverage determination policies and any other payer-specific guidelines
Ensures that all subsequent follow-up activity is established and adheres to a timely schedule
Works with business office staff to understand/trend efforts for authorization-related denials resulting in reduced denials
Maintains accurate records of authorizations with the EMR and payer sites
Maintains professional approach at all times when communicating with patients, co-workers, and payer representatives to ensure a positive and professional experience
Enhances the overall patient care experience through efficient work processes and communication of delays, proactively meeting the patient needs
Collaborates with departments and co-workers to enhance physician and patient satisfaction by utilizing available technologies to streamline verification and financial processes, reduce redundancy of information requested and monitor insurance verification issue/opportunities with third party payers, and provides feedback to Supervisor for implementation of process improvement
Contacts patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary
Informs the patient whether the authorization for the referral has not been approved
Calculates and provides patient liability estimate and educates patient on their insurance benefits as necessary
Requests pre-service payment for patient liability and/or arranges payment plans using appropriate guidelines
Identifies events where Service Recovery is appropriate. Initiates corrective actions and follows through to ensure that not only the recovery is completed but also reoccurrences do not occur
Performs other duties as assigned by Supervisor
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
Identifies and recommends opportunities to improve Patient Access or Financial Clearance activities
Keeps abreast of changing federal, state, and insurance regulations and departmental policies/procedures
Presents facts in a logical pattern and completes summaries to be presented to upper management
Exhibits a positive attitude as it relates to interaction with co-workers, performance of job responsibilities, and a genuine interest in the proper performance of the job
Actively participates in all staff meetings, seminars, training sessions and work groups to advance departmental goals
Maintains CRCS or equivalent certification for Access Professionals
Qualification
Required
High school graduate or GED 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
Preferred
Work in healthcare or business preferred
Associate Degree preferred
Two (2) to three (3) years of work experience with insurance authorization/verification of benefits, revenue cycle functions, hospital/physician offices, or related areas preferred
Company
Smilow Cancer Hospital
At Smilow Cancer Hospital at Yale New Haven, hundreds of specialists are changing the face of cancer treatment.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Jeremy Kortmansky
Associate CMO for Network Medical Services, Chief Network Officer
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