Financial Access Specialist

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 Patient Financial Access Specialist – OP is responsible for all the Patient Financial Access Facilitator functions and responsibilities as well as provides support with complex scheduling in more than one outpatient service area. Utilizing effective communication and effective use of technology, performs a variety of functions including accurate patient identification while adhering to Red Flag procedures to ensure patient safety.

Obtains and updates the patient’s demographic and financial information utilizing multiple computer systems to assure timely processing of the patient’s visit. Functions as the liaison between the physician and the patient in managing appointment and procedure scheduling for both internal and external patient appointments. This individual works closely with patients, physicians and nurse professionals within the clinic setting and is responsible for accurately managing and making decisions related to sequencing of complex procedures, physician appointments, infusion/chemotherapy and other multifaceted services.

Communicates directly with the patient and/or the physician office to ensure instructions, preparations or laboratory test requirements prior to the procedure/appointment have been met. Coordinates multiple patient appointments and manages patient and insurance demographics to ensure appropriate reimbursement for services provided. This individual will be responsible for making decisions around exams ordered as they relate to meeting Medical Necessity and follow up with patient and/or physician when a Waiver or ABN is required.

Individual is cognizant of imaging and other satellite sites across the System and appropriately aligns appointments with patient locations. A major focus in completing these responsibilities will rely on the individual’s attention to detail, specificity and accuracy as it relates to the procedure, the appointment or the chemotherapy, the supporting documentation and an extraordinary level of patient sensitivity and compassion.

Position requires the individual to maintain a high awareness of Service Excellence representing “I am YNHH” at all times and in all locations. Performs certain statistical and QA functions. Helps develop new procedures and participates in the planning, implementation, and training of system improvements to enhance the operating functions of the department.

EEO/AA/Disability/Veteran

• Patient Throughput
  • Ensures all required information obtained from referring physicians and providers in clinical areas are provided to the third party payers to ensure reimbursement for services delivered within the outpatient setting.
  • Accurately schedules patient follow-up physician appointments in the appropriate scheduling system using guidelines and requirements identified within the system.
  • Accurately sequences complex procedures across multiple departments/locations.
  • Accurately schedules and sequences services for patients who desire to go outside of the Yale New Haven medical system.
  • Clearly identifies and communicates dates, times and locations of appointments and procedures with each patient.
  • Enters appropriate “addendum” on the order in EMR identifying date and time of the procedure scheduled. Ensures all referrals, pre-authorizations, and pre-certifications are received prior to services being rendered.
  • Adheres to state and federal guidelines as it pertains to HIPAA and JCAHO requirements and all federal mandates.
• Insurance
  • Demonstrates a solid understanding of the various insurance carriers’ options and completes insurance entry accurately, satisfying billing requirements to ensure a payable account.
  • Exhibits a comprehensive understanding of the online eligibility and insurance website systems including understanding patient’s eligibility, determining benefits and co-pay amount due. Documents appropriate computer…