Pre-Service Center Verification Specialist- Remote

Boston Medical Center (BMC) is more than a hospital. It´s a network of support and care that touches the lives of hundreds of thousands of people in need each year. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all—and is the largest safety-net hospital in New England. The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet – an integrated health care delivery systems that includes many community health centers. Join BMC today and help us achieve our Vision 2030 which is a long-term goal to make Boston the healthiest urban population in the world.

Position: Pre Service Center Verification Specialist- Remote
Department: Patient Access Service
Schedule: Full Time
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 BMC 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 (BMC) practice staff, case management and Patient Financial Counseling. This is a Remote Position.

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, for example) for the scheduled care to proceed. The PSC Verification Specialist is an important part of the larger patient care team and helps clinicians understand what payer requirements are necessary for the widest possible patient access to services.

- Supports BMC staff at all levels for hands-on help understanding and navigating financial clearance issues.

- Uses appropriate strategies to underscore the most efficient process to obtaining insurance verification, authorizations and referrals, including on line databases, electronic correspondence, faxes, and phone calls.

- Obtains and clearly documents all referral/prior authorizations for scheduled services prior to admission within the Epic environment.

- Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients and any other parties to ensure that required managed care referrals and prior authorizations for specified specialty visits and other services are obtained and appropriately recorded in the relevant practice management systems for patient appointments/visits prior to scheduled patient visits or retro-actively if not in place at the time of the appointment/visit. Ensure that approval numbers are appropriately linked to the relevant patie