Pre-Service Center Verification Specialist

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Oversee financial clearance processes related to pre-registration, insurance verification, referrals, prior authorizations, precertifications, and pre-service cash collections.

• Track registration, referral, and prior authorization queues to secure necessary patient and payer-specific clearance information.

• Navigate BMC and payer regulations to obtain approvals and facilitate patient access to services.

• Provide assistance to BMC staff with financial clearance challenges.

• Collect, document, and associate referrals and prior authorizations within Epic and applicable practice management systems.

• Collaborate with practices, physicians, insurance providers, patients, case management, Patient Financial Counseling, and other departments.

• Address registration, insurance verification, referral, and authorization challenges; escalate denied or uncleared accounts as necessary.

• Conduct interviews with patients, families, and referring physicians to gather demographic, financial, insurance, and reimbursement details.

• Create new registration entries and ensure accurate demographic and insurance data is maintained.

• Process copayments, coinsurance, deductibles, and any outstanding patient balances.

• Uphold confidentiality and adhere to HIPAA, legal, regulatory, infection control, and safety guidelines.

• Manage telephone communications in line with scripting and customer service protocols.

• Engage in quality audits, training, process enhancement, and educational initiatives.

• Meet productivity and quality benchmarks and undertake additional assigned tasks.

• Reach out to the IT Help Desk or appropriate vendors regarding malfunctioning systems or equipment.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• 1–3 years of experience in hospital registration and/or insurance is preferred.

• Minimum of one year in a customer service position is required.

• Basic understanding of healthcare terminology and CPT-ICD10 codes is essential.

• Comprehensive knowledge of insurance is preferred.

• Proven customer service abilities and the capacity to exercise judgment, independent thinking, and creativity when addressing customer concerns.

• Outstanding interpersonal skills.

• Strong written and verbal communication skills.

• Ability to operate in a complex environment with diverse perspectives.

• Good decision-making and judgment skills; attention to detail is crucial.

• Knowledge of and experience with Epic is preferred.

• Technical proficiency in Epic workqueues and ancillary systems, including ADT/Prelude/Grand Centrale.

• Commitment to maintaining confidentiality of personal and health-sensitive information.

• Capacity to manage challenging situations and prioritize multiple tasks.

• Basic computer skills, including familiarity with Microsoft Excel, Word, Outlook, and Zoom.

• Understanding of Revenue Cycle processes and the ability to meet productivity standards.

• Willingness to participate in required hospital and departmental training.

• Must comply with BMC’s RESPECT behavioral standards.

🏝️ Benefits

• Medical, dental, vision, and pharmacy benefits.

• Contract increases.

• Flexible Spending Accounts.

• 403(b) savings matches.

• Earned time cash out.

• Paid time off.

• Opportunities for career advancement.

• Resources available to support employee and family wellbeing.

• Educational programs and development opportunities.

• Remote work options.