Pre-Service Center Verification Specialist

Position: Pre-Service Center Verification Specialist
Department: Ambulatory
Schedule: Full Time
This is a fully remote position. The initial three weeks of training, as well as ongoing job responsibilities, will be completed remotely.
POSITION SUMMARY:

The Pre Service Center (PSC) Verification Specialist role belongs to the Revenue Cycle Patient Access team and is responsible for coordinating all financial clearance activities by navigating all pre-registration (to include acquiring or validating patient demographic, insurance, and other required elements along with insurance verification activities), obtaining referral authorization, or precertification number(s), pre-service cash collections. The role ensures timely access to care while maximizing BMCHS hospital reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations. This position reports to the Pre Service Center Supervisor and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, Boston Medical Center (BMCHS) practice staff, case management and Patient Financial Counseling. This is a Remote Position.
JOB REQUIREMENTS

EDUCATION:

High School Diploma or GED required, Associates degree or higher preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED :
EXPERIENCE:

1-3 years Hospital registration and/or Insurance experience desirable. At least one year of experience must be in a customer service role.
KNOWLEDGE AND SKILLS:

- General knowledge of healthcare terminology and CPT-ICD10 codes.

- Complete understanding of insurance is preferred.

- Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues.

- Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers.

- Able to communicate effectively in writing.

- Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view.

- Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.

- Knowledge of and experience within Epic is preferred.

- Demonstrates technical proficiency within assigned Epic workqueues and applicable ancillary systems, including but not limited to: ADT/Prelude/Grand Centrale.

- Must be able to maintain strict confidentiality of all personal/health sensitive information.

- Ability to effectively handle challenging situations and to balance multiple priorities.

- Basic computer proficiency inclusive of ability to access, enter and interpret computerized data/information including proficiency in Microsoft Suite applications, specifically Excel, Word, Outlook and Zoom.

- Displays a thorough knowledge of various sections within the work unit in order to provide assistance and back-up coverage as directed.

- Displays a deep understanding of Revenue Cycle processes and applies knowledge to meet and maintain productivity standards as outlined by Management.

ESSENTIAL RESPONSIBILITIES / DUTIES:

- Monitors accounts routed to registration, referral and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines.

- Maintains knowledge of and complies with insurance companies’ requirements for obtaining prior authorizations/referrals, and completes other activities to facilitate all aspects of financial clearance.

- Acts as subject matter experts in navigating both the BMC and payer policies to get the appropriate approvals (authorizations, pre-certs, referrals,