Senior Patient Finance Representative

• 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, and working in accordance with required State and Federal regulations and hospital policies.

• 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.

• Contacting PCP (primary care physician) offices to secure referrals and entering referrals into the patient accounting system.

• Collaborating with clinical departments, case managers, and clinical liaisons to ensure payer authorizations are obtained timely.

• Proactively engaging patients and family members to determine coverage limitations and financial liability.

• Communicating with physician offices, service sites, and ancillary departments if referrals/authorizations are denied at least 72 hours prior to the service date.

• 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:

• High School/GED is required.
• 1 year of direct experience working with health insurance, referrals and authorizations is required.
• Ability to communicate effectively in English both orally and in writing and provide empathy in difficult interpersonal situations.
• Ability to resolve complex problems requiring the use of basic scientific, mathematical, or technical principles is required.
• Well-developed customer service skills and a good understanding of computer systems are required. Familiarity with basic medical terminology is required.
• Effective organizational skills and the ability to work in a fast-paced environment to ensure completion of work within established timeframes.
• Attention to detail and completion of tasks with accuracy.
• This is fully remote position.

Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

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