At Boston Children's Hospital, success is measured in patients treated, parents comforted and teams taught. It's in discoveries made, processes perfected, and technology advanced. In major medical breakthroughs and small acts of kindness. And in colleagues who have your back and patients who have your heart. As a teaching hospital of Harvard Medical School, our reach is global and our impact is profound. Join our acclaimed Innovation organization and discover how your talents can change lives. Yours included.
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. Working in accordance with required State and Federal regulations and hospital policies.
Proactively engaging patients and family members to determine coverage limitations and financial liability.
Contacting PCP (primary care physician) offices to secure referrals and entering 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:
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.
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.
The ability to work as part of a team with diverse internal and external constituencies.
Effective organizational skills and the ability to work in a fast-paced environment to ensure completion of assignments within established time frames.
Attention to detail and completion of tasks with accuracy.
*** Candidates will be obtaining Prior Authorizations in this position. ***
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, 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.
Internal Number: 2855867
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.