Financial Clearance Analyst

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.

EEO/AA/Disability/Veteran

• 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,…