Boston Medical Center (BMC)
Pre-Service Verification Specialist
Boston Medical Center (BMC), Boston, Massachusetts, us, 02298
Pre‑Service Verification Specialist
Position Summary
The Pre‑Service Center (PSC) Verification Specialist, part of the Revenue Cycle Patient Access team, coordinates financial clearance activities for patient pre‑registration, insurance verification, referral authorization, pre‑certification numbers, and pre‑service cash collections. The daily responsibilities include navigating patient and payer policies, ensuring timely access to care and maximizing hospital reimbursement while adhering to quality assurance guidelines and productivity standards. This remote position reports to the Pre Service Center Supervisor and collaborates with stakeholders such as insurance representatives, physicians, practice staff, case management, and patient financial counseling.
Essential Responsibilities / Duties
Monitor accounts routed to registration, referral, and prior authorization work queues and clear them by obtaining all necessary patient and/or payer‑specific financial clearance elements in accordance with established guidelines.
Maintain knowledge of insurance company requirements for prior authorizations/referrals and complete activities to facilitate all aspects of financial clearance.
Serve as a subject‑matter expert navigating BMC and payer policies to obtain authorizations, pre‑certs, and referrals for scheduled care and help clinicians understand payer requirements.
Assist BMC staff at all levels with financial clearance issues and explain procedures to patients, physicians, and other stakeholders.
Utilize online databases, electronic correspondence, faxes, and phone calls to obtain insurance verification, authorizations, and referrals efficiently.
Document all referral/prior authorizations for scheduled services prior to admission in Epic and ensure approval numbers are linked to the correct patient appointment.
Collaborate with primary and specialty practices, referring physicians, insurance carriers, patients, and internal departments to obtain all required managed care referrals and prior authorizations for specialty visits and other services, recording them in the practice management system.
When a valid referral does not exist, contact the appropriate party to generate or obtain referral/authorization information and record it in the system.
Interview patients, families, or referring physicians by telephone before appointments to obtain necessary financial and demographic information.
Accept registration updates from various intake points (paper forms, internet registration, telephones, etc.) and ensure all updated demographic and insurance information is accurately recorded.
Review and reconcile registration and insurance information in systems with carriers, contacting patients for clarifications, maintaining sensitivity and customer‑friendly approach.
Create new registration records for new patients, generating medical record numbers and completing full registration.
Process copayments, coinsurance, deductibles, and outstanding patient balances during pre‑registration.
Maintain confidentiality of patient financial and medical records, comply with state and federal laws, and advise management of potential compliance issues.
Participate in educational offerings and development opportunities as assigned; comply with all organizational workflows, policies, and procedures.
Demonstrate knowledge and skills to provide the level of customer experience aligned with management expectations.
Recognize situations requiring escalation to the supervisor and collaborate with revenue cycle staff for continuous improvement.
Handle telephone calls promptly, following scripting and customer service standards, managing calls or referring to appropriate party as needed.
Undergo Managed Care Quality Audits to meet required standards.
Contact the Help Desk for system or hardware issues and report unresolved problems to supervisor.
Organize and maintain a clean, efficient work area.
Communicate with internal and external customers effectively and courteously, maintaining HIPAA compliance and following infection control and safety procedures.
Attend required training; perform other related duties as assigned.
Education and Experience High School Diploma or GED required; Associate’s degree or higher preferred.
1‑3 years of hospital registration and/or insurance experience desirable; at least one year in a customer‑service role is required.
Knowledge, Skills & Abilities
General knowledge of healthcare terminology and CPT‑ICD10 codes.
Comprehensive understanding of insurance processes preferred.
Strong customer service skills with independent judgment and creative problem‑solving.
Exceptional interpersonal skills for building relationships with patients, physicians, staff, and other customers.
Effective written and verbal communication skills.
Comfortable with ambiguity, good decision‑making and judgment, attention to detail.
Knowledge of Epic and ancillary systems (ADT/Prelude/Grand Centrale) preferred.
Technical proficiency in Epic work queues and related systems.
Strict confidentiality of personal health information.
Ability to handle challenging situations and balance multiple priorities.
Basic computer proficiency, including Microsoft Office (Excel, Word, Outlook, Zoom).
Knowledge of revenue cycle processes to meet productivity standards.
Compensation $24.05–$29.31 per hour. Salary range reflects base pay; total compensation includes benefits (medical, dental, vision, pharmacy), contract increases, FSA, 403(b) matching, paid time off, career advancement opportunities, and additional resources for employee and family wellbeing.
Equal Opportunity Boston Medical Center is an Equal Opportunity Employer. We comply with all federal, state, and local laws. We encourage applications from disabled veterans and all qualified individuals regardless of race, color, religion, sex, gender identity, sexual orientation, national origin, age, or other protected status.
Required Standards The Pre‑Service Verification Specialist must adhere to BMC’s RESPECT behavioral standards, maintain confidentiality of patient records, and follow all state, federal, and enterprise confidentiality policies.
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Essential Responsibilities / Duties
Monitor accounts routed to registration, referral, and prior authorization work queues and clear them by obtaining all necessary patient and/or payer‑specific financial clearance elements in accordance with established guidelines.
Maintain knowledge of insurance company requirements for prior authorizations/referrals and complete activities to facilitate all aspects of financial clearance.
Serve as a subject‑matter expert navigating BMC and payer policies to obtain authorizations, pre‑certs, and referrals for scheduled care and help clinicians understand payer requirements.
Assist BMC staff at all levels with financial clearance issues and explain procedures to patients, physicians, and other stakeholders.
Utilize online databases, electronic correspondence, faxes, and phone calls to obtain insurance verification, authorizations, and referrals efficiently.
Document all referral/prior authorizations for scheduled services prior to admission in Epic and ensure approval numbers are linked to the correct patient appointment.
Collaborate with primary and specialty practices, referring physicians, insurance carriers, patients, and internal departments to obtain all required managed care referrals and prior authorizations for specialty visits and other services, recording them in the practice management system.
When a valid referral does not exist, contact the appropriate party to generate or obtain referral/authorization information and record it in the system.
Interview patients, families, or referring physicians by telephone before appointments to obtain necessary financial and demographic information.
Accept registration updates from various intake points (paper forms, internet registration, telephones, etc.) and ensure all updated demographic and insurance information is accurately recorded.
Review and reconcile registration and insurance information in systems with carriers, contacting patients for clarifications, maintaining sensitivity and customer‑friendly approach.
Create new registration records for new patients, generating medical record numbers and completing full registration.
Process copayments, coinsurance, deductibles, and outstanding patient balances during pre‑registration.
Maintain confidentiality of patient financial and medical records, comply with state and federal laws, and advise management of potential compliance issues.
Participate in educational offerings and development opportunities as assigned; comply with all organizational workflows, policies, and procedures.
Demonstrate knowledge and skills to provide the level of customer experience aligned with management expectations.
Recognize situations requiring escalation to the supervisor and collaborate with revenue cycle staff for continuous improvement.
Handle telephone calls promptly, following scripting and customer service standards, managing calls or referring to appropriate party as needed.
Undergo Managed Care Quality Audits to meet required standards.
Contact the Help Desk for system or hardware issues and report unresolved problems to supervisor.
Organize and maintain a clean, efficient work area.
Communicate with internal and external customers effectively and courteously, maintaining HIPAA compliance and following infection control and safety procedures.
Attend required training; perform other related duties as assigned.
Education and Experience High School Diploma or GED required; Associate’s degree or higher preferred.
1‑3 years of hospital registration and/or insurance experience desirable; at least one year in a customer‑service role is required.
Knowledge, Skills & Abilities
General knowledge of healthcare terminology and CPT‑ICD10 codes.
Comprehensive understanding of insurance processes preferred.
Strong customer service skills with independent judgment and creative problem‑solving.
Exceptional interpersonal skills for building relationships with patients, physicians, staff, and other customers.
Effective written and verbal communication skills.
Comfortable with ambiguity, good decision‑making and judgment, attention to detail.
Knowledge of Epic and ancillary systems (ADT/Prelude/Grand Centrale) preferred.
Technical proficiency in Epic work queues and related systems.
Strict confidentiality of personal health information.
Ability to handle challenging situations and balance multiple priorities.
Basic computer proficiency, including Microsoft Office (Excel, Word, Outlook, Zoom).
Knowledge of revenue cycle processes to meet productivity standards.
Compensation $24.05–$29.31 per hour. Salary range reflects base pay; total compensation includes benefits (medical, dental, vision, pharmacy), contract increases, FSA, 403(b) matching, paid time off, career advancement opportunities, and additional resources for employee and family wellbeing.
Equal Opportunity Boston Medical Center is an Equal Opportunity Employer. We comply with all federal, state, and local laws. We encourage applications from disabled veterans and all qualified individuals regardless of race, color, religion, sex, gender identity, sexual orientation, national origin, age, or other protected status.
Required Standards The Pre‑Service Verification Specialist must adhere to BMC’s RESPECT behavioral standards, maintain confidentiality of patient records, and follow all state, federal, and enterprise confidentiality policies.
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