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 Specialist is responsible for ensuring that payers are prepared to reimburse Corporate Business Services (CBS) for scheduled services in accordance with the payer-provider contract. When physicians and clinicians make care decisions, the Financial Clearance Specialist is aware of how a patient's benefits fit into the care plan, and keeps patients and physicians informed of such as they seek of obtain authorizations from payers. This position is responsible for the financial clearance of transplant, surgical, chemotherapy, and radiation therapy patients, including insurance verification, price estimation, and validation of medical necessity for certain services. This position will maintain a proficient understanding of third-party payer regulations and guidelines for these particular service lines, including a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that these patients often require. In addition, will determine benefit and coverage levels and connects patients with financial assistance resources as needed. In all encounters with patients and families, the Financial Clearance Specialist will strive for the highest level of customer service.

EEO/AA/Disability/Veteran Responsibilities:

1. Verifies patients' insurance and benefits information for transplant, surgical, chemotherapy, and radiation therapy patients.
1.1 Exhibits understanding of various insurance carrier options and verifies eligibility as outlined in departmental procedures.
2. Obtains prior authorizations from third-party payers in accordance with payer requirements.
2.1 Utilizes all necessary Epic applications from booking to obtain procedure codes as needed.
3. Maintains professional approach at all times when communicating with patients, co-workers, and payer representatives to ensure a positive and professional experience.
3.1 Contacts patients as needed to gather demographic and insurance information, and updates patient information within the EMR as necessary.
4. Performs other duties as assigned by Supervisor to support revenue cycle operations.
4.1 Maintains a proficient understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that these patients often require.

Qualifications:

EDUCATION

High school graduate or GED required with work in healthcare or business preferred. Bachelor's Degree preferred. CPC, LPN, Pharmacology License or other medical degree or equivalent preferred. CRCS or equivalent certification for Access Professionals required within 18 months of hire. Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status preferred.

EXPERIENCE

Three (3) to four (4) years of work experience with insurance authorization/verification of benefits, revenue cycle functions, hospital/physician offices, or related areas required.

LICENSURE

CRCS or equivalent certification for Access Professionals required within 18 months of hire. Certified Medical Assistant (CMS), Licensed Practical Nurse (LPN), or Certified Professional Coder (CPC) status preferred.

SPECIAL SKILLS

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 required. Basic understanding of diagnostic testing and procedure codes (CPT, HCPCS, ICD-9-CM/PCS, and ICD-10-CM/PCS coding, etc.). Maintains a proficient understanding of third-party payer regulations and guidelines for transplant, surgical, chemotherapy, and radiation therapy service lines, including a working knowledge of medical necessity requirements for the pharmaceuticals and recurring services that these patients often require. Demonstrates attention to detail and ability to multitask. Advanced knowledge of Microsoft Office, Word, and Excel.