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This Senior Financial Clearance Specialist will be responsible for:
- Managing daily assignments using standardized protocols and work queues to ensure timely completion of financial clearance in accordance with departmental processes and payer guidelines
- Collecting, verifying, and recording all demographic information required for patient financial clearance in accordance with hospital policy
- Verifying insurance eligibility utilizing available technologies, payer websites, or by phone contact with third party payers. Works in accordance with required State and Federal regulations and hospital policies
- Proactively engages patients and family members to determine coverage limitations and financial liability
- Contacting PCP (primary care physician) offices to secure referrals and enter referrals into patient accounting system
- Communicating with physician offices, service sites and ancillary departments if referrals/authorizations are denied at least 72 hours prior to service date
- Ensuring that correct insurance company name, address, plan, and filing order are recorded in the patient accounting system
- Using payer exception reports to update coverage / PCP information
- Collaborating with clinical departments, case managers and clinical liaison to ensure payer authorizations are obtained timely
- Facilitating peer to peer reviews when needed to secure authorizations
- Documenting all actions taken on accounts with clear and concise account notes
- Participating in process improvement activities
To qualify you must have.
This position is eligible for an Employee Referral Bonus.
- Work requires the knowledge of theories, principles, and concepts typically acquired through completion of High School- Bachelor's Degree preferred, with minimum of one year of direct experience working with health insurance, referrals and authorizations
- Understanding of Microsoft Office and Experience with Epic registration system a plus
- Work requires the ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations
- The ability to resolve moderately complex problems requiring the use of basic scientific, mathematical, or technical principles is required
- Work requires the ability to work as part of a team with diverse internal and external constituencies
- Work requires effective organizational skills and the ability to work in a fast-paced environment to ensure completion of assignments within established time frames.
- Work requires attention to detail and completion of tasks with accuracy
Boston Children's Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, cell phone plan discounts and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
Department: Finance-Patient Access Center
Schedule: Mon - Fri, 8:00am - 4:30pm
Standard Hours Per Week: 40