Boston Medical Center
Pre-Service Center Verification Specialist- Remote
Boston Medical Center, Boston, Massachusetts, us, 02298
Overview
Boston Medical Center (BMC) is 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 the primary teaching affiliate of Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet. Join BMC today and help us achieve our Vision 2030 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 coordinates all financial clearance activities, including pre-registration elements, insurance verification, obtaining referral authorizations or precertification numbers, and pre-service cash collections. The role ensures timely access to care while maximizing BMC hospital reimbursement. This position adheres to quality assurance guidelines and productivity standards and reports to the Pre Service Center Supervisor. Collaboration with insurance company representatives, patients, physicians, BMC practice staff, case management and Patient Financial Counseling is required. This is a Remote Position. Essential Responsibilities / Duties
Monitor accounts routed to registration, referral and prior authorization work queues and clear them by obtaining necessary patient and payer-specific financial clearance elements. Maintain knowledge of and comply with insurance requirements for prior authorizations/referrals and facilitate all aspects of financial clearance. Navigate BMC and payer policies to obtain approvals (authorizations, pre-certs, referrals) for scheduled care; support clinicians in understanding payer requirements for broad patient access. Provide hands-on assistance to BMC staff in understanding and navigating financial clearance issues. Use appropriate strategies to obtain insurance verification, authorizations and referrals, including online databases, electronic correspondence, faxes, and phone calls. Obtain and document all referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborate with practices, referring physicians, insurance carriers and patients to ensure required referrals and prior authorizations are recorded in relevant systems for appointments, and link approval numbers to patient visits. If a valid referral is not present, generate or obtain the referral/authorization and record it in the practice management system. Contact internal and external primary care physicians to obtain referral/authorization numbers. Perform follow-up activities indicated by management reports and work queues. Collaborate with patients, providers and departments to obtain necessary information and payer permissions before scheduled services. Communicate with patients, providers and departments such as Utilization Review to resolve issues with obtaining required referrals/authorizations. Work with practices to resolve registration, insurance verification, referral or authorization issues that impact coverage. Escalate accounts that have been denied or will not be financially cleared according to department policy. Interview patients, families or referring physicians by telephone in advance of appointments to obtain financial and demographic information required for reimbursement and compliance. Accept registration updates from various intake points and ensure updated demographic and insurance information is recorded in the registration systems for primary, secondary and tertiary insurances. Review registration and insurance information and reconcile with insurer data; validate updated information and contact patients if clarifications are needed, maintaining a customer-friendly approach. For new patients, create a new registration record, obtain required data elements, generate a medical record number, and complete full registration. Refer patients with self-pay or unresolved insurance to Patient Financial Counseling. Process current copayments, coinsurance, and deductibles for scheduled visits and outstanding balances during pre-registration. Maintain confidentiality of patient financial and medical records; comply with HIPAA and applicable laws and policies; report potential compliance issues promptly. Participate in educational offerings and comply with organizational workflows, policies and procedures. Demonstrate customer experience skills aligned with BMC management expectations and escalate issues to the Supervisor when needed. Collaborate with revenue cycle staff to support continuous improvement and learn other roles/processes as directed. Meet productivity and quality expectations; handle calls in a timely and professional manner; manage calls or route to appropriate parties. Participate in Managed Care Quality Audits to meet required standards. Report system or hardware issues to Help Desk and notify supervisors if not addressed promptly; coordinate with vendors for service as needed. Organize and maintain an efficient, neat, and safe work area; communicate effectively with internal and external customers; maintain patient confidentiality and HIPAA compliance. Follow infection control and safety procedures; attend required training; perform other duties as assigned. Job Requirements Education:
High School Diploma or GED required; Associate degree or higher preferred. Certificates, Licenses, Registrations Required:
— Experience:
1-3 years 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. Complete understanding of insurance is preferred. Demonstrated customer service skills with judgment, independent thinking and creativity in resolving issues. Excellent interpersonal skills to build relationships with patients, physicians, management, staff and other customers. Effective written communication and strong verbal communication; ability to work in a complex environment and balance multiple points of view. Comfort with ambiguity, good decision making and attention to detail. Knowledge of Epic is preferred; proficiency with Epic work queues and related systems (ADT/Prelude/Grand Central). Ability to maintain strict confidentiality of personal/health information. Ability to handle challenging situations and prioritize effectively. Basic computer proficiency with Microsoft Excel, Word, Outlook and Zoom. Understanding of Revenue Cycle processes and ability to meet 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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Boston Medical Center (BMC) is 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 the primary teaching affiliate of Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet. Join BMC today and help us achieve our Vision 2030 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 coordinates all financial clearance activities, including pre-registration elements, insurance verification, obtaining referral authorizations or precertification numbers, and pre-service cash collections. The role ensures timely access to care while maximizing BMC hospital reimbursement. This position adheres to quality assurance guidelines and productivity standards and reports to the Pre Service Center Supervisor. Collaboration with insurance company representatives, patients, physicians, BMC practice staff, case management and Patient Financial Counseling is required. This is a Remote Position. Essential Responsibilities / Duties
Monitor accounts routed to registration, referral and prior authorization work queues and clear them by obtaining necessary patient and payer-specific financial clearance elements. Maintain knowledge of and comply with insurance requirements for prior authorizations/referrals and facilitate all aspects of financial clearance. Navigate BMC and payer policies to obtain approvals (authorizations, pre-certs, referrals) for scheduled care; support clinicians in understanding payer requirements for broad patient access. Provide hands-on assistance to BMC staff in understanding and navigating financial clearance issues. Use appropriate strategies to obtain insurance verification, authorizations and referrals, including online databases, electronic correspondence, faxes, and phone calls. Obtain and document all referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborate with practices, referring physicians, insurance carriers and patients to ensure required referrals and prior authorizations are recorded in relevant systems for appointments, and link approval numbers to patient visits. If a valid referral is not present, generate or obtain the referral/authorization and record it in the practice management system. Contact internal and external primary care physicians to obtain referral/authorization numbers. Perform follow-up activities indicated by management reports and work queues. Collaborate with patients, providers and departments to obtain necessary information and payer permissions before scheduled services. Communicate with patients, providers and departments such as Utilization Review to resolve issues with obtaining required referrals/authorizations. Work with practices to resolve registration, insurance verification, referral or authorization issues that impact coverage. Escalate accounts that have been denied or will not be financially cleared according to department policy. Interview patients, families or referring physicians by telephone in advance of appointments to obtain financial and demographic information required for reimbursement and compliance. Accept registration updates from various intake points and ensure updated demographic and insurance information is recorded in the registration systems for primary, secondary and tertiary insurances. Review registration and insurance information and reconcile with insurer data; validate updated information and contact patients if clarifications are needed, maintaining a customer-friendly approach. For new patients, create a new registration record, obtain required data elements, generate a medical record number, and complete full registration. Refer patients with self-pay or unresolved insurance to Patient Financial Counseling. Process current copayments, coinsurance, and deductibles for scheduled visits and outstanding balances during pre-registration. Maintain confidentiality of patient financial and medical records; comply with HIPAA and applicable laws and policies; report potential compliance issues promptly. Participate in educational offerings and comply with organizational workflows, policies and procedures. Demonstrate customer experience skills aligned with BMC management expectations and escalate issues to the Supervisor when needed. Collaborate with revenue cycle staff to support continuous improvement and learn other roles/processes as directed. Meet productivity and quality expectations; handle calls in a timely and professional manner; manage calls or route to appropriate parties. Participate in Managed Care Quality Audits to meet required standards. Report system or hardware issues to Help Desk and notify supervisors if not addressed promptly; coordinate with vendors for service as needed. Organize and maintain an efficient, neat, and safe work area; communicate effectively with internal and external customers; maintain patient confidentiality and HIPAA compliance. Follow infection control and safety procedures; attend required training; perform other duties as assigned. Job Requirements Education:
High School Diploma or GED required; Associate degree or higher preferred. Certificates, Licenses, Registrations Required:
— Experience:
1-3 years 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. Complete understanding of insurance is preferred. Demonstrated customer service skills with judgment, independent thinking and creativity in resolving issues. Excellent interpersonal skills to build relationships with patients, physicians, management, staff and other customers. Effective written communication and strong verbal communication; ability to work in a complex environment and balance multiple points of view. Comfort with ambiguity, good decision making and attention to detail. Knowledge of Epic is preferred; proficiency with Epic work queues and related systems (ADT/Prelude/Grand Central). Ability to maintain strict confidentiality of personal/health information. Ability to handle challenging situations and prioritize effectively. Basic computer proficiency with Microsoft Excel, Word, Outlook and Zoom. Understanding of Revenue Cycle processes and ability to meet 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.
#J-18808-Ljbffr