Boston Medical Center (BMC)
Pre Service Center Verification Specialist
Boston Medical Center (BMC), Boston, Massachusetts, us, 02298
Pre Service Center Verification Specialist
Boston Medical Center (BMC) invites applications for the Pre Service Center Verification Specialist role. The PSC Verification Specialist is a remote position within the Revenue Cycle Patient Access team. The specialist coordinates all pre‑registration financial clearance activities, including patient and insurer data acquisition, insurance verification, referral authorizations and pre‑certifications. The role ensures timely access to care while maximizing hospital reimbursement. The position reports to the Pre Service Center Supervisor and requires strict adherence to quality assurance guidelines and productivity expectations.
Position Summary Pre‑registration, insurance verification, referral, and pre‑certification activities are carried out by the PSC Verification Specialist. The specialist navigates institutional and payer policies to obtain the necessary approvals for scheduled care, supports clinicians, and collaborates with primary care and specialty practices, insurance carriers, patients, and internal teams such as utilization review and patient financial counseling.
Qualifications
High School Diploma or GED required; Associate’s degree or higher preferred.
1‑3 years hospital registration and/or insurance experience desirable.
At least one year in a customer service role.
General knowledge of healthcare terminology and CPT‑ICD10 codes.
Complete understanding of insurance systems and processes.
Demonstrated customer service skills with independent judgment and creativity.
Exceptional interpersonal skills, ability to maintain effective relationships with patients, physicians, management, staff, and other customers.
Excellent verbal and written communication skills.
Comfortable with ambiguity, good decision‑making and judgment capabilities, attention to detail.
Knowledge of and experience within Epic preferred.
Technical proficiency in Epic workqueues and ancillary systems (ADT/Prelude/Grand Centrale).
Strict confidentiality of all personal/health sensitive information.
Proficiency with Microsoft Suite (Excel, Word, Outlook, Zoom).
Strong analytical and problem‑solving skills.
Effective handling of challenging situations and balanced prioritization.
Deep understanding of Revenue Cycle processes and application of knowledge to meet productivity standards.
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 expert in navigating both BMC and payer policies to obtain the appropriate approvals (authorizations, pre‑certs, referrals, for example) for scheduled care.
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 online 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 other parties to ensure required managed care referrals and prior authorizations 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.
When it is determined that a valid referral does not exist, utilize computer‑based tools or contact the appropriate party to obtain/generate referral/authorization and related information. Record the referral/authorization in the practice management system.
Contact internal and external primary care physicians to obtain referral/authorization numbers.
Perform follow‑up activities indicated by relevant management reports and work queues.
Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients’ scheduled services.
Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations.
Work collaboratively with the practices to resolve registration, insurance verification, referral or authorization issue to the extent that these unresolved issues impact the ability to obtain a referral/authorization.
Escalates accounts that have been denied or will not be financially cleared as outlined by department policy.
Interview patients, families or referring physicians via telephone in advance of the patient’s appointment/visit whenever possible, to obtain all necessary information, including but not limited to, financial and demographic information required for reimbursement and compliance for services rendered.
Accept registration updates from various intake points, including but not limited to those received via paper forms, internet registration forms, telephones located in practices and direct calls from patients.
Ensure that all updated demographic and insurance information is accurately recorded in the appropriate registration systems for primary, secondary and tertiary insurances.
Review all registration and insurance information in systems and reconcile with information available from insurance carriers. For any insurance updates, utilize any available resources to validate the updated insurance information, insurance plan eligibility, primary care physician, subscriber information, employer information and appointment/visit information. Contact patients as necessary if clarifications or other follow‑up is required, and at all times maintain sensitivity and a clear customer‑friendly approach.
For any patient who is new to Boston Medical Center, create a new registration record, accurately obtaining all required data elements, including generating a medical record number and complete a full registration for the patient.
For self‑pay patients or patients with unresolved insurance, and for financial counseling, refer patients to Patient Financial Counseling.
Process current copayments, coinsurance, and/or deductibles for scheduled visits and outstanding patient balances for prior patient accounts during the pre‑registration process.
Maintains confidentiality of patient’s financial and medical records; adheres to the State and Federal laws regulating collection in healthcare; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately.
Participates in educational offerings sponsored by BMC or other development opportunities as assigned/available and complies with all applicable organizational workflows, as well as established policies and procedures.
Demonstrates knowledge & skills necessary to provide level of customer experience as aligned with BMC management expectations.
Demonstrates the ability to recognize situations that require escalation to the Supervisor.
Establishes relationships and effectively collaborates with revenue cycle staff to support continuous improvement aligned with BMC management expectations as outlined.
Takes opportunity to know and learn other roles and processes and works together to assist with process improvement initiatives as directed.
Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities.
Handle telephone calls in a timely fashion, following applicable scripting and customer service standards. Appropriately manage all calls by either working with the customer or referring the call to the appropriate party.
Regularly undergo Managed Care Quality Audits to achieve the required standard.
Contact the Help Desk in the BMC Information Technology Department to report faulty systems or hardware. Notify area supervisor or manager if problem is not addressed in a timely manner.
Organize and maintain work area for efficiency, neatness and safety.
Communicate with all internal and external customers effectively and courteously.
Maintain patient confidentiality, including but not limited to, compliance with HIPAA.
Follow established hospital infection control and safety procedures.
Attend all necessary hospital and department training as required.
Perform other related duties as assigned or required.
Compensation Range $24.05 - $29.31 per hour
Seniority Level Entry level
Employment Type Full‑time
Job Function Other
Industries Hospitals and Health Care
Equal Opportunity Employer/Disabled/Veterans Boston Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability status, veteran status or any other protected characteristic.
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Position Summary Pre‑registration, insurance verification, referral, and pre‑certification activities are carried out by the PSC Verification Specialist. The specialist navigates institutional and payer policies to obtain the necessary approvals for scheduled care, supports clinicians, and collaborates with primary care and specialty practices, insurance carriers, patients, and internal teams such as utilization review and patient financial counseling.
Qualifications
High School Diploma or GED required; Associate’s degree or higher preferred.
1‑3 years hospital registration and/or insurance experience desirable.
At least one year in a customer service role.
General knowledge of healthcare terminology and CPT‑ICD10 codes.
Complete understanding of insurance systems and processes.
Demonstrated customer service skills with independent judgment and creativity.
Exceptional interpersonal skills, ability to maintain effective relationships with patients, physicians, management, staff, and other customers.
Excellent verbal and written communication skills.
Comfortable with ambiguity, good decision‑making and judgment capabilities, attention to detail.
Knowledge of and experience within Epic preferred.
Technical proficiency in Epic workqueues and ancillary systems (ADT/Prelude/Grand Centrale).
Strict confidentiality of all personal/health sensitive information.
Proficiency with Microsoft Suite (Excel, Word, Outlook, Zoom).
Strong analytical and problem‑solving skills.
Effective handling of challenging situations and balanced prioritization.
Deep understanding of Revenue Cycle processes and application of knowledge to meet productivity standards.
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 expert in navigating both BMC and payer policies to obtain the appropriate approvals (authorizations, pre‑certs, referrals, for example) for scheduled care.
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 online 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 other parties to ensure required managed care referrals and prior authorizations 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.
When it is determined that a valid referral does not exist, utilize computer‑based tools or contact the appropriate party to obtain/generate referral/authorization and related information. Record the referral/authorization in the practice management system.
Contact internal and external primary care physicians to obtain referral/authorization numbers.
Perform follow‑up activities indicated by relevant management reports and work queues.
Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients’ scheduled services.
Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations.
Work collaboratively with the practices to resolve registration, insurance verification, referral or authorization issue to the extent that these unresolved issues impact the ability to obtain a referral/authorization.
Escalates accounts that have been denied or will not be financially cleared as outlined by department policy.
Interview patients, families or referring physicians via telephone in advance of the patient’s appointment/visit whenever possible, to obtain all necessary information, including but not limited to, financial and demographic information required for reimbursement and compliance for services rendered.
Accept registration updates from various intake points, including but not limited to those received via paper forms, internet registration forms, telephones located in practices and direct calls from patients.
Ensure that all updated demographic and insurance information is accurately recorded in the appropriate registration systems for primary, secondary and tertiary insurances.
Review all registration and insurance information in systems and reconcile with information available from insurance carriers. For any insurance updates, utilize any available resources to validate the updated insurance information, insurance plan eligibility, primary care physician, subscriber information, employer information and appointment/visit information. Contact patients as necessary if clarifications or other follow‑up is required, and at all times maintain sensitivity and a clear customer‑friendly approach.
For any patient who is new to Boston Medical Center, create a new registration record, accurately obtaining all required data elements, including generating a medical record number and complete a full registration for the patient.
For self‑pay patients or patients with unresolved insurance, and for financial counseling, refer patients to Patient Financial Counseling.
Process current copayments, coinsurance, and/or deductibles for scheduled visits and outstanding patient balances for prior patient accounts during the pre‑registration process.
Maintains confidentiality of patient’s financial and medical records; adheres to the State and Federal laws regulating collection in healthcare; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately.
Participates in educational offerings sponsored by BMC or other development opportunities as assigned/available and complies with all applicable organizational workflows, as well as established policies and procedures.
Demonstrates knowledge & skills necessary to provide level of customer experience as aligned with BMC management expectations.
Demonstrates the ability to recognize situations that require escalation to the Supervisor.
Establishes relationships and effectively collaborates with revenue cycle staff to support continuous improvement aligned with BMC management expectations as outlined.
Takes opportunity to know and learn other roles and processes and works together to assist with process improvement initiatives as directed.
Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities.
Handle telephone calls in a timely fashion, following applicable scripting and customer service standards. Appropriately manage all calls by either working with the customer or referring the call to the appropriate party.
Regularly undergo Managed Care Quality Audits to achieve the required standard.
Contact the Help Desk in the BMC Information Technology Department to report faulty systems or hardware. Notify area supervisor or manager if problem is not addressed in a timely manner.
Organize and maintain work area for efficiency, neatness and safety.
Communicate with all internal and external customers effectively and courteously.
Maintain patient confidentiality, including but not limited to, compliance with HIPAA.
Follow established hospital infection control and safety procedures.
Attend all necessary hospital and department training as required.
Perform other related duties as assigned or required.
Compensation Range $24.05 - $29.31 per hour
Seniority Level Entry level
Employment Type Full‑time
Job Function Other
Industries Hospitals and Health Care
Equal Opportunity Employer/Disabled/Veterans Boston Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability status, veteran status or any other protected characteristic.
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