Boston Medical Center (BMC) is hiring a Per Diem Insurance Verification Specialist. This role is part of the Revenue Cycle Patient Access team, coordinating financial clearance by navigating referral, precertification, and authorization requirements. You will help ensure patient access to care while maximizing hospital reimbursement.
What You'll Do
- Monitor accounts in precertification and prior authorization work queues, clearing them by obtaining all payer-specific financial clearance requirements.
- Act as a subject matter expert in navigating BMC Community and payer systems to obtain necessary permissions for care plans.
- Use various strategies to efficiently obtain authorizations, including online databases, electronic correspondence, faxes, and phone calls.
- Obtain and clearly document all pre-certifications and prior authorizations for scheduled services within Epic prior to admission.
- Collaborate with patients, providers, and other departments to obtain necessary information and payer permissions before scheduled services.
- Communicate with patients, providers, and Utilization Review to resolve issues with required pre-certifications or authorizations.
- Escalate emergent and elective accounts that are denied or will not be financially cleared within 3 days of admission per policy.
- Keep current on CMS requirements and guidelines.
- Coordinate with patients and Patient Financial Counseling to initiate or process Charity Care applications as needed.
What We're Looking For
- High School Diploma or Equivalent
Nice to Have
- Associates degree or higher
- Case manager and/or coding certification
- 4-5 years of medical billing, denials, coding, and/or inpatient admitting experience
- Complete understanding of insurance
- Knowledge of and experience within Epic
Technical Stack
- Epic (ADT/Prelude/Grand Central, HB & PB Resolute)
- Microsoft Suite (Excel, Word, Outlook)
Team & Environment
You will be part of the Revenue Cycle Patient Access team.
Benefits & Compensation
- Compensation: $24.05- $29.31
- Benefits (medical, dental, vision, pharmacy)
- Flexible Spending Accounts
- 403(b) savings matches
- Earned time cash out
- Paid time off
- Career advancement opportunities
- Resources to support employee and family wellbeing
Work Mode
This role is onsite.
Boston Medical Center (BMC) is an Equal Opportunity Employer/Disabled/Veterans.
