Specialty Svc Line 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 Specialty Service Line Analyst coordinates the review of insurance benefits for potential transplant and donor patients at Yale-New Haven Health in order to facilitate the process for the patient to be placed on the transplant list. They advocate on behalf of the patients throughout the registration and financial clearance process, working directly with the clinical staff, families and insurance company representatives to ensure all financial, educational and scheduling needs are met. Must possess critical thinking skills and ability to meet the specific needs of the role accurately and independently. Ensures positive interactions with patients, family members, medical staff, third party representatives and hospital personnel to ensure that departmental, financial and compliance objectives are achieved. Performs certain statistical and QA functions. Works with management and team members to develop new procedures and participates in the planning and implementation of system improvements to enhance the operating functions of the department. Supports the team in daily operations and decisions concerning work-flow. Demonstrates resourcefulness and compassion in educating and communicating insurance coverage or lack of coverage to patients, as well as assisting them with completing applications for alternative coverage / funding.

EEO/AA/Disability/VeteranResponsibilities:

• 1. Responsible for all aspects of the transplant process, including complete pre-transplant financial clearance and assessment, post-transplant follow-up, coordination of services, pharmacy, organ acquisition, travel and lodging, and maintenance services for the extent of the services provided to the patient and potential candidate. Provides necessary clinical information in order to obtain and verify transplant coverage. Determines if pre-certification is required for evaluation, transplant admission and/or follow-up care. Makes multiple calls to a variety of parties in order to obtain coverage and for the patient to be placed on the transplant list.
• 2. Promotes and acts as a resource, educates and counsels patients and family regarding their coverage and financial responsibilities at the onset of the process. Meets with prospective patient and their families to discuss benefit coverage and potential issues. Provides information regarding available sources and potential resources.
• 3. Possesses an understanding of each essential components for all transplant types. Acts as a resource and assists patients in completing applications for coverage (insurance, Free Care, pharmaceutical, grant/search approval applications) as well as with alternative funding (National Transplant Assist Fund, Leukemia & Lymphoma Society, Cancer Care, etc.).
• 4. Collaborates with the coordinators in scheduling and ensuring financial clearance and specific authorizations for the various patient tests/appointments are in place. Ensures patient transportation is in place and facilitates if necessary. Keeps transplant team informed of patient's financial situation and status within the process.
• 5. Exhibits excellence in customer service by supporting, advocating, and adhering to the standards outlined in Yale New Haven Health Standards of Professional Behavior. Works collaboratively with staff to create a patient /family, physician and employee experience that exemplifies caring, understand, efficiency and overall quality of service. Demonstrates the ability to balance customer service with the financial needs of the hospital. Acts as a role model to ensure high levels of patient satisfaction and displays compassion at all times.
• 6. Exhibits a high degree of problem solving skills and resourcefulness to resolve issues. Takes necessary steps to address problems or refers issues to the appropriate person or department for resolution. Makes certain that problems have been resolved to avoid unnecessary stress to patients. Recommends and implements reasonable solutions to address problems.
• 7. Maintains a strong working knowledge of all current computer systems used in registration, scheduling, accounts receivable, Web and Internet insurance eligibility systems. Utilizes Microsoft packages. Participates in internal and external committees as related to the enhancement or development of computer systems.
• 8. Maintains current knowledge of federal regulations and insurance guidelines for transplant reimbursement.
• 9. Contributes in clinical meetings to provide updates and explanations regarding insurance benefit requirements as it pertains to services leading up to transplant and subsequent treatment after.
• 10. Acts as a resource for transplant accounts, retrospectively analyzes accounts to ensure proper methodology has been used. Conducts operational audits of areas within the department to identify departures from policy and of other functional system problems. Makes recommendations for improvement to management.
• 11. Evaluates account level detail to identify trends or shifts in registration, authorization requirements or billing practices that impact the quality of performance and makes recommendations to management team.
• 12. Performs all other duties as requested to maintain a smooth operation of the department and contributes to overall group goals.

Qualifications:

EDUCATION

Bachelor's degree in Business Administration or related area preferred. Medical Terminology certification and knowledge of CPT and HCPCS coding strongly preferred.

EXPERIENCE

Minimum of Five (5) years progressive experience in multiple departments throughout the revenue cycle including registration, authorization, billing/claims, system analysis and reimbursement. Extensive third party familiarity and a strong exposure to transplantation (including donor) benefits. A minimum of one (1) year of direct patient contact.

LICENSURE

Certified Healthcare Access Associate (CHAA) through the National Association of Healthcare Access Management (NAHAM) or Certified Revenue Cycle Specialist (CRCS) through AAHAM required within 18 months of hire. Medical Terminology certification and knowledge of CPT and HCPCS coding strongly preferred.

SPECIAL SKILLS

Excellent interpersonal, analytical and communication (oral and written) skills. Excellent customer service skills. Knowledge and experience with medical terminology. Ability to interpret insurance benefits, authorization requirements and calculate estimated patient portions due. Ability to confidently and compassionately communicate and educate patients. Demonstrated technical proficiency including experience with insurance verification/eligibility tools, Epic EMR, patient liability estimation tools, and Microsoft Office. Ability to interpret guidelines established by health care industry and government agencies directly related to transplant and donor services.