[Hiring] Pre Service Center Verification Specialist @BMC Software

Role Description

The Pre Service Center (PSC) Verification Specialist role belongs to the Revenue Cycle Patient Access team and is responsible for coordinating all financial clearance activities by navigating all pre-registration, obtaining referral authorization, or precertification number(s), and pre-service cash collections. This role ensures timely access to care while maximizing BMC hospital reimbursement.

• Monitors accounts routed to registration, referral and prior authorization work queues.
• Maintains knowledge of and complies with insurance companies’ requirements for obtaining prior authorizations/referrals.
• Acts as subject matter experts in navigating both the BMC and payer policies.
• Supports BMC staff at all levels for hands-on help understanding financial clearance issues.
• Uses appropriate strategies to obtain insurance verification, authorizations, and referrals.
• Obtains and documents all referral/prior authorizations for scheduled services within the Epic environment.
• Works collaboratively with various stakeholders to ensure required managed care referrals and prior authorizations are obtained.
• Utilizes computer-based tools to obtain/generate referral/authorization and related information.
• Contacts internal and external primary care physicians to obtain referral/authorization numbers.
• Performs follow-up activities indicated by relevant management reports and work queues.
• Collaborates with patients, providers, and departments to obtain necessary information and payer permissions.
• Communicates with patients and providers to resolve issues with obtaining required referral/prior authorizations.
• Escalates accounts that have been denied or will not be financially cleared.
• Interviews patients, families, or referring physicians to obtain necessary information.
• Accepts registration updates from various intake points.
• Ensures all updated demographic and insurance information is accurately recorded.
• Reviews all registration and insurance information and reconciles with information from insurance carriers.
• Creates a new registration record for patients new to Boston Medical Center.
• Processes current copayments, coinsurance, and/or deductibles for scheduled visits.
• Maintains confidentiality of patient’s financial and medical records.
• Participates in educational offerings and complies with organizational workflows.
• Demonstrates knowledge & skills necessary to provide a high level of customer experience.
• Establishes relationships and collaborates with revenue cycle staff for continuous improvement.
• Handles telephone calls in a timely fashion, following applicable scripting and customer service standards.
• Regularly undergoes Managed Care Quality Audits to achieve required standards.
• Organizes and maintains work area for efficiency, neatness, and safety.
• Communicates effectively and courteously with all internal and external customers.
• Follows established hospital infection control and safety procedures.
• Performs other related duties as assigned or required.

Qualifications

• High School Diploma or GED required; Associates degree or higher preferred.
• 1-3 years of hospital registration and/or insurance experience desirable.
• At least one year of experience must be in a customer service role.
• General knowledge of healthcare terminology and CPT-ICD10 codes.
• Complete understanding of insurance is preferred.
• Demonstrated customer service skills.
• Exceptional interpersonal skills.
• Able to communicate effectively in writing.
• Requires excellent verbal communication skills.
• Knowledge of and experience within Epic is preferred.
• Basic computer proficiency, including Microsoft Suite applications.

Requirements

• Must be able to maintain strict confidentiality of all personal/health sensitive information.
• Ability to effectively handle challenging situations and balance multiple priorities.
• Displays a thorough knowledge of various sections within the work unit.
• Displays a deep understanding of Revenue Cycle processes.

Benefits

• Compensation Range: $24.41- $29.75.
• Generous total compensation including benefits (medical, dental, vision, pharmacy).
• Contract increases and Flexible Spending Accounts.
• 403(b) savings matches and earned time cash out.
• Paid time off and career advancement opportunities.
• Resources to support employee and family wellbeing.

Company Description

Equal Opportunity Employer/Disabled/Veterans. According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website.