Boston Medical Center (BMC)
Pre-Service Center Verification Specialist
Boston Medical Center (BMC), Boston, Massachusetts, us, 02298
Position: Pre-Service Center Verification Specialist
Department: Ambulatory
Schedule: Full Time
Note: While this position is remote, at this time we are only considering local candidates because the initial three weeks of training must be conducted on site in Quincy MA.
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 (including acquiring or validating patient demographic, insurance and other required elements along with insurance verification activities), 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 requires adherence to quality assurance guidelines and 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 stakeholders in the financial clearance process, including but not limited to insurance company representatives, patients, physicians, BMC practice staff, case management and Patient Financial Counseling. This is a remote position. Education & Experience
Education High School Diploma or GED required; Associate degree or higher preferred. Experience 1-3 years hospital registration and/or insurance experience desirable. At least one year of experience must be in a customer service role. CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED As applicable per department policy. 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 and the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers. Able to communicate effectively in writing and verbally; able to work in a complex environment with varying points of view. Comfortable with ambiguity; strong decision making and judgment capabilities; attention to detail. Knowledge of and experience within Epic is preferred. Proficiency with Epic workqueues and applicable ancillary systems (e.g., ADT/Prelude/Grand Central). Maintain strict confidentiality of all personal/health sensitive information. Ability to handle challenging situations and balance multiple priorities. Basic computer proficiency, including Microsoft Excel, Word, Outlook and Zoom. Understanding of Revenue Cycle processes and ability to meet productivity standards. Ability to provide assistance and backup coverage within the work unit. Essential Responsibilities / Duties
Monitor accounts routed to registration, referral and prior authorization work queues and clear them by obtaining all necessary patient and payer-specific financial clearance elements in accordance with established guidelines. Maintain knowledge of and comply with insurance requirements for obtaining prior authorizations/referrals and complete related activities to facilitate financial clearance. Act as subject matter expert in navigating BMC and payer policies to obtain approvals (authorizations, pre-certs, referrals) for scheduled care. Support BMC staff with understanding and navigating financial clearance issues. Use appropriate strategies to obtain insurance verification, authorizations and referrals via online databases, electronic methods, faxes and phone calls. Obtain and document all referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborate with practices, providers, insurance carriers and patients to ensure required referrals and authorizations are recorded in appropriate systems for appointments. When a valid referral does not exist, generate or obtain the necessary referral/authorization and record it in the practice management system. Contact internal and external physicians to obtain referral/authorization numbers. Perform follow-up activities as indicated by management reports and workflows. Collaborate with patients, providers, and departments to obtain necessary information and payer permissions prior to scheduled services. Resolve issues with obtaining referrals/authorizations by communicating with patients, providers, and departments. Escalate accounts that are denied or not financially cleared as per department policy. Interview patients, families or referring physicians in advance of appointments when possible to obtain necessary financial and demographic information. Accept registration updates from various intake points and ensure updated demographics and insurance information are accurately recorded in registration systems. Review and reconcile registration and insurance information; validate updated insurance information and eligibility; contact patients for clarification as needed while maintaining a customer-friendly approach. For new patients, create a new registration record, generate a medical record number, and complete full registration. For self-pay or unresolved insurance cases, refer to Patient Financial Counseling as appropriate. Process current copayments, coinsurance, and deductibles during pre-registration. Maintain confidentiality of patient financial and medical records and comply with applicable laws and policies; notify management of potential compliance issues. Participate in educational offerings and comply with workflows, policies and procedures. Demonstrate knowledge and skills to provide the customer experience expected by management. Escalate to the Supervisor when situations require higher-level review. Collaborate with revenue cycle staff to support continuous improvement aligned with management expectations. Support process improvements and cross-training as directed. Meet productivity and quality expectations and manage calls according to scripting and standards. Participate in Managed Care Quality Audits to achieve required standards. (The above statements are intended to depict the general nature of the work and are not exhaustive. IND123) Equal Opportunity Employer/Disabled/Veterans Important notice:
Our current job openings are listed on our website. We do not request downloads or offers via text messages or social media. Do not purchase equipment for employment.
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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 (including acquiring or validating patient demographic, insurance and other required elements along with insurance verification activities), 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 requires adherence to quality assurance guidelines and 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 stakeholders in the financial clearance process, including but not limited to insurance company representatives, patients, physicians, BMC practice staff, case management and Patient Financial Counseling. This is a remote position. Education & Experience
Education High School Diploma or GED required; Associate degree or higher preferred. Experience 1-3 years hospital registration and/or insurance experience desirable. At least one year of experience must be in a customer service role. CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED As applicable per department policy. 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 and the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers. Able to communicate effectively in writing and verbally; able to work in a complex environment with varying points of view. Comfortable with ambiguity; strong decision making and judgment capabilities; attention to detail. Knowledge of and experience within Epic is preferred. Proficiency with Epic workqueues and applicable ancillary systems (e.g., ADT/Prelude/Grand Central). Maintain strict confidentiality of all personal/health sensitive information. Ability to handle challenging situations and balance multiple priorities. Basic computer proficiency, including Microsoft Excel, Word, Outlook and Zoom. Understanding of Revenue Cycle processes and ability to meet productivity standards. Ability to provide assistance and backup coverage within the work unit. Essential Responsibilities / Duties
Monitor accounts routed to registration, referral and prior authorization work queues and clear them by obtaining all necessary patient and payer-specific financial clearance elements in accordance with established guidelines. Maintain knowledge of and comply with insurance requirements for obtaining prior authorizations/referrals and complete related activities to facilitate financial clearance. Act as subject matter expert in navigating BMC and payer policies to obtain approvals (authorizations, pre-certs, referrals) for scheduled care. Support BMC staff with understanding and navigating financial clearance issues. Use appropriate strategies to obtain insurance verification, authorizations and referrals via online databases, electronic methods, faxes and phone calls. Obtain and document all referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborate with practices, providers, insurance carriers and patients to ensure required referrals and authorizations are recorded in appropriate systems for appointments. When a valid referral does not exist, generate or obtain the necessary referral/authorization and record it in the practice management system. Contact internal and external physicians to obtain referral/authorization numbers. Perform follow-up activities as indicated by management reports and workflows. Collaborate with patients, providers, and departments to obtain necessary information and payer permissions prior to scheduled services. Resolve issues with obtaining referrals/authorizations by communicating with patients, providers, and departments. Escalate accounts that are denied or not financially cleared as per department policy. Interview patients, families or referring physicians in advance of appointments when possible to obtain necessary financial and demographic information. Accept registration updates from various intake points and ensure updated demographics and insurance information are accurately recorded in registration systems. Review and reconcile registration and insurance information; validate updated insurance information and eligibility; contact patients for clarification as needed while maintaining a customer-friendly approach. For new patients, create a new registration record, generate a medical record number, and complete full registration. For self-pay or unresolved insurance cases, refer to Patient Financial Counseling as appropriate. Process current copayments, coinsurance, and deductibles during pre-registration. Maintain confidentiality of patient financial and medical records and comply with applicable laws and policies; notify management of potential compliance issues. Participate in educational offerings and comply with workflows, policies and procedures. Demonstrate knowledge and skills to provide the customer experience expected by management. Escalate to the Supervisor when situations require higher-level review. Collaborate with revenue cycle staff to support continuous improvement aligned with management expectations. Support process improvements and cross-training as directed. Meet productivity and quality expectations and manage calls according to scripting and standards. Participate in Managed Care Quality Audits to achieve required standards. (The above statements are intended to depict the general nature of the work and are not exhaustive. IND123) Equal Opportunity Employer/Disabled/Veterans Important notice:
Our current job openings are listed on our website. We do not request downloads or offers via text messages or social media. Do not purchase equipment for employment.
#J-18808-Ljbffr