Pre - service Center Verification Specialist - Remote - Remote Eligible

Pre Service Center Verification Specialist- Remote

Boston Medical Center (BMC) is more than a hospital. It´s a network of support and care that touches the lives of hundreds of thousands of people in need each year. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all—and is the largest safety-net hospital in New England. The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet – an integrated health care delivery systems that includes many community health centers. Join BMC today and help us achieve our Vision 2030 which is a long-term goal to make Boston the healthiest urban population in the world.

Position: Pre Service Center Verification Specialist- Remote

Department: Patient Access Service

Schedule: Full Time

POSITION SUMMARY:

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 (to include acquiring or validating patient demographic, insurance, and other required elements along with insurance verification activities), obtaining referral authorization, or precertification number(s), pre-service cash collections. The role ensures timely access to care while maximizing BMC hospital reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. This position reports to the Pre Service Center Supervisor and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, Boston Medical Center (BMC) practice staff, case management, and Patient Financial Counseling. This is a Remote Position.

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 experts in navigating both the BMC and payer policies to get the appropriate approvals (authorizations, pre-certs, referrals, for example) for the scheduled care to proceed. The PSC Verification Specialist is an important part of the larger patient care team and helps clinicians understand what payer requirements are necessary for the widest possible patient access to services.
• 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 any other parties to ensure that required managed care referrals and prior authorizations for specified specialty visits and other services are obtained and appropriately recorded in the relevant practice management systems for patient appointments/visits prior to scheduled patient visits or retroactively if not in place at the time of the appointment/visit. Ensure that approval numbers are appropriately linked to the relevant patient 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 WQ's.
• 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. For other broken or malfunctioning equipment to be serviced, contact the appropriate vendor or department and notify supervisor.
• 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.

Must adhere to all of BMC's RESPECT behavioral standards.

The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required.

JOB REQUIREMENTS

EDUCATION:

High School Diploma or GED required, Associates degree or higher preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

EXPERIENCE:

1-3 years Hospital registration and/or Insurance experience desirable. At least one year of experience must be in a customer service role.

KNOWLEDGE AND SKILLS:

• General knowledge of healthcare terminology and CPT-ICD10 codes.
• Complete understanding of insurance is preferred.
• Demonstrated customer