Boston Medical Center (BMC)
Pre-Service Center Verification Specialist- Remote
Boston Medical Center (BMC), Boston, Massachusetts, us, 02298
Overview
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Pre-Service Center Verification Specialist- Remote
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. Boston Medical Center (BMC) is the largest and busiest provider of trauma and emergency services in New England. It emphasizes community-based care and is the primary teaching affiliate of Boston University School of Medicine. This Remote role supports the Revenue Cycle Patient Access team by coordinating all financial clearance activities to ensure timely access to care while maximizing hospital reimbursement. Position Summary
The Pre Service Center (PSC) Verification Specialist coordinates all financial clearance activities by navigating pre-registration (demographic, insurance, and other required elements), obtaining referral authorizations or precertifications, and pre-service cash collections. The role adheres to quality assurance guidelines and productivity standards and collaborates with insurance representatives, patients, physicians, 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 them by obtaining necessary financial clearance elements in line with guidelines. Maintains knowledge of insurance requirements for prior authorizations/referrals and facilitates financial clearance. Acts as subject matter expert navigating BMC and payer policies to obtain approvals for scheduled care. Supports BMC staff with financial clearance issues and helps clinicians understand payer requirements for access to services. Uses online databases, electronic correspondence, faxes, and phone calls to obtain insurance verification, authorizations and referrals. Obtains and documents referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborates with practices, physicians, insurers, and patients to ensure required referrals and authorizations are recorded in practice management systems; links approval numbers to patient appointments/visits. When a valid referral is missing, uses tools or contacts parties to obtain/generate referral/authorization and records it in the practice management system. Contacts internal and external physicians to obtain referral/authorization numbers. Performs follow-up activities per management reports and work queues. Collaborates with patients, providers, and departments to obtain necessary information and payer permissions prior to scheduled services. Communicates with patients, providers, and departments to resolve issues with obtaining required authorizations. Resolves registration, insurance verification, referral or authorization issues to prevent delays in referrals/authorizations. Escalates accounts that are denied or not financially cleared as per policy. Interviews patients, families or referring physicians by telephone to obtain necessary information for reimbursement and compliance. Accepts registration updates from various intake points and records updated demographic and insurance information accurately. Reviews registration and insurance information, validates updates, and contacts patients if clarifications are needed; maintains confidentiality and a customer-friendly approach. For new patients, creates a new registration record including medical record number and full registration. For self-pay or unresolved insurance cases, refer to Patient Financial Counseling and process copayments, coinsurance, and/or deductibles during pre-registration. Maintains confidentiality of patient financial and medical records; adheres to HIPAA and confidentiality policies; complies with infection control and safety procedures; participates in required trainings. Demonstrates customer experience standards, recognizes when escalation is needed, and collaborates with revenue cycle staff for process improvement. Maintains productivity and quality expectations and handles calls per scripting and customer service standards. Participates in Managed Care Quality Audits and reports system or equipment issues to Help Desk and supervisors as needed. Maintains an organized and safe work area and professional communication with internal and external customers. Protects patient confidentiality and adheres to regulatory requirements; performs additional duties as assigned. Education / Experience / Knowledge & Skills Education High School Diploma or GED required; Associates degree or higher preferred. Experience 1-3 years of hospital registration and/or insurance experience desirable; at least one year in a customer service role. Knowledge And Skills General knowledge of healthcare terminology and CPT-ICD10 codes; understanding of insurance is preferred; strong customer service and interpersonal skills; effective written and verbal communication; ability to handle ambiguity and multi-task; experience with Epic is preferred; proficiency with Epic workqueues and systems (e.g., ADT/Prelude/Grand Central); ability to maintain confidentiality; strong computer skills (Excel, Word, Outlook, Zoom); understanding of Revenue Cycle processes and productivity standards. Equal Opportunity Employer/Disabled/Veterans According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps”; job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
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Join to apply for the
Pre-Service Center Verification Specialist- Remote
role at
. Boston Medical Center (BMC) is the largest and busiest provider of trauma and emergency services in New England. It emphasizes community-based care and is the primary teaching affiliate of Boston University School of Medicine. This Remote role supports the Revenue Cycle Patient Access team by coordinating all financial clearance activities to ensure timely access to care while maximizing hospital reimbursement. Position Summary
The Pre Service Center (PSC) Verification Specialist coordinates all financial clearance activities by navigating pre-registration (demographic, insurance, and other required elements), obtaining referral authorizations or precertifications, and pre-service cash collections. The role adheres to quality assurance guidelines and productivity standards and collaborates with insurance representatives, patients, physicians, 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 them by obtaining necessary financial clearance elements in line with guidelines. Maintains knowledge of insurance requirements for prior authorizations/referrals and facilitates financial clearance. Acts as subject matter expert navigating BMC and payer policies to obtain approvals for scheduled care. Supports BMC staff with financial clearance issues and helps clinicians understand payer requirements for access to services. Uses online databases, electronic correspondence, faxes, and phone calls to obtain insurance verification, authorizations and referrals. Obtains and documents referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborates with practices, physicians, insurers, and patients to ensure required referrals and authorizations are recorded in practice management systems; links approval numbers to patient appointments/visits. When a valid referral is missing, uses tools or contacts parties to obtain/generate referral/authorization and records it in the practice management system. Contacts internal and external physicians to obtain referral/authorization numbers. Performs follow-up activities per management reports and work queues. Collaborates with patients, providers, and departments to obtain necessary information and payer permissions prior to scheduled services. Communicates with patients, providers, and departments to resolve issues with obtaining required authorizations. Resolves registration, insurance verification, referral or authorization issues to prevent delays in referrals/authorizations. Escalates accounts that are denied or not financially cleared as per policy. Interviews patients, families or referring physicians by telephone to obtain necessary information for reimbursement and compliance. Accepts registration updates from various intake points and records updated demographic and insurance information accurately. Reviews registration and insurance information, validates updates, and contacts patients if clarifications are needed; maintains confidentiality and a customer-friendly approach. For new patients, creates a new registration record including medical record number and full registration. For self-pay or unresolved insurance cases, refer to Patient Financial Counseling and process copayments, coinsurance, and/or deductibles during pre-registration. Maintains confidentiality of patient financial and medical records; adheres to HIPAA and confidentiality policies; complies with infection control and safety procedures; participates in required trainings. Demonstrates customer experience standards, recognizes when escalation is needed, and collaborates with revenue cycle staff for process improvement. Maintains productivity and quality expectations and handles calls per scripting and customer service standards. Participates in Managed Care Quality Audits and reports system or equipment issues to Help Desk and supervisors as needed. Maintains an organized and safe work area and professional communication with internal and external customers. Protects patient confidentiality and adheres to regulatory requirements; performs additional duties as assigned. Education / Experience / Knowledge & Skills Education High School Diploma or GED required; Associates degree or higher preferred. Experience 1-3 years of hospital registration and/or insurance experience desirable; at least one year in a customer service role. Knowledge And Skills General knowledge of healthcare terminology and CPT-ICD10 codes; understanding of insurance is preferred; strong customer service and interpersonal skills; effective written and verbal communication; ability to handle ambiguity and multi-task; experience with Epic is preferred; proficiency with Epic workqueues and systems (e.g., ADT/Prelude/Grand Central); ability to maintain confidentiality; strong computer skills (Excel, Word, Outlook, Zoom); understanding of Revenue Cycle processes and productivity standards. Equal Opportunity Employer/Disabled/Veterans According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps”; job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
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