Boston Medical Center (BMC)
Pre Service Center (PSC) Verification Specialist
Boston Medical Center (BMC), Boston, Massachusetts, us, 02298
Position Summary
Gather information for patient registration for various ambulatory department patients. Schedule appointments, verify demographic, insurance, and financial information for patients. Coordinate and arrange for primary care provider approvals for services provided to managed care patients in specialty clinic areas such as Pulmonary/Asthma, Infectious Diseases, and Urgent Care Clinics. Serve in the role of Patient Access Representative in any medicine clinic when needed. Position Details
Job Title:
Pre Service Center (PSC) Verification Specialist Department:
Ambulatory Schedule:
Full Time 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, completing other activities to facilitate all aspects of financial clearance. Acts as subject matter expert in navigating both the BMC and payer policies to obtain the appropriate approvals (authorizations, pre‑certs, referrals) for scheduled care. Supports BMC staff at all levels for hands‑on help understanding and navigating financial clearance issues. Uses appropriate strategies to streamline insurance verification, authorizations and referrals, including online databases, electronic correspondence, faxes and phone calls. Obtains and documents all referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborates with primary care practices, specialty practices, referring physicians, insurance carriers, patients and other parties to ensure required managed care referrals and prior authorizations are obtained and recorded in relevant practice management systems. When a valid referral does not exist, obtains/generates the referral/authorization and records it in the practice management system. Communicates with patients, providers and departments such as Utilization Review to resolve issues related to required referral/prior authorizations. Escalates denied or non‑cleared accounts as outlined by department policy. Interviews patients, families or referring physicians via telephone to obtain necessary financial, demographic and compliance information. Accepts registration updates from various intake points, including paper forms, internet registration forms, phones and direct calls. Ensures all updated demographic and insurance information is accurately recorded for primary, secondary and tertiary insurances. Reconciles registration and insurance information with carriers and validates eligibility, primary care physician, subscriber information and appointment details. Creates new registration records for patients new to BMC, generating a medical record number and completing full registration. Refers self‑pay patients or patients with unresolved insurance to Patient Financial Counseling. Processes copayments, coinsurance, deductibles and outstanding balances during pre‑registration. Maintains confidentiality of patient financial and medical records, adheres to state and federal laws and enterprise policies, and reports compliance issues immediately. Participates in educational offerings and development opportunities, complying with all organizational workflows, policies and procedures. Demonstrates customer‑service skills aligned with BMC expectations, recognizes situations requiring escalation, and collaborates with revenue cycle staff for continuous improvement. Meets productivity and quality expectations, handles telephone calls timely, undergoes Managed Care Quality Audits, reports IT issues to the Help Desk, and maintains work area ergonomics. Communicates effectively and courteously with all internal and external customers, maintains HIPAA compliance, follows infection control and safety procedures, attends required training, and performs other related duties as assigned. Education
High School Diploma or GED required; Associate’s degree or higher preferred. Experience
1–3 years of hospital registration and/or insurance experience desirable. At least one year of experience in a customer service role. Certificates, Licenses, Registrations Required
None specified. Knowledge And Skills
General knowledge of healthcare terminology and CPT‑ICD10 codes. Complete understanding of insurance preferred. Demonstrated customer service skills with judgment, independent thinking and creativity. Exceptional interpersonal skills; ability to establish and maintain effective relationships with patients, physicians, management, staff and other customers. Effective written communication skills. Excellent verbal communication and ability to work in a complex environment with varying viewpoints. Comfortable with ambiguity; good decision‑making and judgment; attention to detail. Knowledge of and experience within Epic preferred. Technical proficiency in Epic work queues and ancillary systems including ADT/Prelude/Grand Centrale. Maintenance of strict confidentiality of sensitive information. Ability to handle challenging situations and balance multiple priorities. Basic computer proficiency, including Microsoft Suite (Excel, Word, Outlook, Zoom). Knowledge of work unit sections to provide assistance and back‑up coverage as directed. Understanding of Revenue Cycle processes and application of knowledge to meet productivity standards set by management. Compensation Range
$24.05–$29.31 per hour. This range is an estimate based on minimum qualifications; total compensation includes benefits (medical, dental, vision, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and other resources supporting employee and family wellbeing. Equal Opportunity Employer
Boston Medical Center is an equal opportunity employer that complies with the FTC’s guidelines on employment offer scams. Applications are accepted solely through the BMC website.
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Gather information for patient registration for various ambulatory department patients. Schedule appointments, verify demographic, insurance, and financial information for patients. Coordinate and arrange for primary care provider approvals for services provided to managed care patients in specialty clinic areas such as Pulmonary/Asthma, Infectious Diseases, and Urgent Care Clinics. Serve in the role of Patient Access Representative in any medicine clinic when needed. Position Details
Job Title:
Pre Service Center (PSC) Verification Specialist Department:
Ambulatory Schedule:
Full Time 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, completing other activities to facilitate all aspects of financial clearance. Acts as subject matter expert in navigating both the BMC and payer policies to obtain the appropriate approvals (authorizations, pre‑certs, referrals) for scheduled care. Supports BMC staff at all levels for hands‑on help understanding and navigating financial clearance issues. Uses appropriate strategies to streamline insurance verification, authorizations and referrals, including online databases, electronic correspondence, faxes and phone calls. Obtains and documents all referral/prior authorizations for scheduled services prior to admission within the Epic environment. Collaborates with primary care practices, specialty practices, referring physicians, insurance carriers, patients and other parties to ensure required managed care referrals and prior authorizations are obtained and recorded in relevant practice management systems. When a valid referral does not exist, obtains/generates the referral/authorization and records it in the practice management system. Communicates with patients, providers and departments such as Utilization Review to resolve issues related to required referral/prior authorizations. Escalates denied or non‑cleared accounts as outlined by department policy. Interviews patients, families or referring physicians via telephone to obtain necessary financial, demographic and compliance information. Accepts registration updates from various intake points, including paper forms, internet registration forms, phones and direct calls. Ensures all updated demographic and insurance information is accurately recorded for primary, secondary and tertiary insurances. Reconciles registration and insurance information with carriers and validates eligibility, primary care physician, subscriber information and appointment details. Creates new registration records for patients new to BMC, generating a medical record number and completing full registration. Refers self‑pay patients or patients with unresolved insurance to Patient Financial Counseling. Processes copayments, coinsurance, deductibles and outstanding balances during pre‑registration. Maintains confidentiality of patient financial and medical records, adheres to state and federal laws and enterprise policies, and reports compliance issues immediately. Participates in educational offerings and development opportunities, complying with all organizational workflows, policies and procedures. Demonstrates customer‑service skills aligned with BMC expectations, recognizes situations requiring escalation, and collaborates with revenue cycle staff for continuous improvement. Meets productivity and quality expectations, handles telephone calls timely, undergoes Managed Care Quality Audits, reports IT issues to the Help Desk, and maintains work area ergonomics. Communicates effectively and courteously with all internal and external customers, maintains HIPAA compliance, follows infection control and safety procedures, attends required training, and performs other related duties as assigned. Education
High School Diploma or GED required; Associate’s degree or higher preferred. Experience
1–3 years of hospital registration and/or insurance experience desirable. At least one year of experience in a customer service role. Certificates, Licenses, Registrations Required
None specified. Knowledge And Skills
General knowledge of healthcare terminology and CPT‑ICD10 codes. Complete understanding of insurance preferred. Demonstrated customer service skills with judgment, independent thinking and creativity. Exceptional interpersonal skills; ability to establish and maintain effective relationships with patients, physicians, management, staff and other customers. Effective written communication skills. Excellent verbal communication and ability to work in a complex environment with varying viewpoints. Comfortable with ambiguity; good decision‑making and judgment; attention to detail. Knowledge of and experience within Epic preferred. Technical proficiency in Epic work queues and ancillary systems including ADT/Prelude/Grand Centrale. Maintenance of strict confidentiality of sensitive information. Ability to handle challenging situations and balance multiple priorities. Basic computer proficiency, including Microsoft Suite (Excel, Word, Outlook, Zoom). Knowledge of work unit sections to provide assistance and back‑up coverage as directed. Understanding of Revenue Cycle processes and application of knowledge to meet productivity standards set by management. Compensation Range
$24.05–$29.31 per hour. This range is an estimate based on minimum qualifications; total compensation includes benefits (medical, dental, vision, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and other resources supporting employee and family wellbeing. Equal Opportunity Employer
Boston Medical Center is an equal opportunity employer that complies with the FTC’s guidelines on employment offer scams. Applications are accepted solely through the BMC website.
#J-18808-Ljbffr