Verification & Eligibility Specialist

Brigham & Women's Faulkner Hospital; Pelham; On-site; CAD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Verification & Eligibility Specialist to join their Rehabilitation Services team. In this role, you will be responsible for ensuring accurate patient information and eligibility for services, coordinating with both internal and external stakeholders. The ideal candidate will have a strong background in insurance authorization and excellent communication skills. This position offers a unique opportunity to contribute to patient care in a supportive environment, where diversity and inclusion are valued. If you are dedicated to improving patient experiences and thrive in a dynamic setting, this role is perfect for you.

Qualifications

• 2-3 years experience in insurance authorization preferred.
• Ability to perform analytical and decision-making functions with minimal supervision.

Responsibilities

• Ensures proper insurance and billing address are assigned in the system.
• Contacts third-party payers to verify patient eligibility and authorization status.

Skills

Insurance Authorization

Customer Service

Communication Skills

Analytical Skills

Problem Solving

Education

High School diploma or GED

Tools

EPIC

Microsoft Office

Job description

The Verification & Eligibility Specialist for Rehabilitation Services performs a variety of authorization, referral, and eligibility functions related to the hospital's patient account receivable, in accordance with the hospital's policies, government and third-party payer requirements, and HIPAA/regulatory guidelines. Responsible for ensuring all procedures are cleared 48 hours prior to the service date. Coordinates activities with internal and external customers.

1. Ensures proper insurance, plan choice, prioritization, and billing address are assigned in the system.
2. Updates accurate demographic information for patients, guarantors, and subscribers.
3. Documents all actions taken on accounts with complete and accurate notes.
4. Contacts third-party and government payers to verify and obtain patient eligibility, authorization, and referral status.
5. Performs duties electronically and uses phone only when necessary.
6. Demonstrates understanding of authorization and referral needs based on payer and service.
7. Communicates effectively with internal and external sources to resolve or adjudicate claims via verbal and written correspondence.
8. Informs supervisors of matters affecting payment and contributes to problem-solving efforts.
9. Demonstrates thorough knowledge of MediTech functionality for updates and documentation.
10. Uses payer websites, NEHEN, and clearinghouses (Emdeon) effectively.
11. Collaborates with Collections regarding authorization status and provides documentation for appeals.
12. Contacts patients, service areas, and physician's offices regarding issues affecting payments.
13. Ensures accounts are cleared 7 days to 48 hours prior to the service date.
14. Follows up on reminders and reports to ensure timely completion.
15. Maintains patient privacy and confidentiality per HIPAA.
16. Performs other duties as assigned.

About Brigham and Women's Faulkner Hospital:
Brigham and Women's Faulkner Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teaching, and community service. We value diversity, equity, and inclusion, reflecting the community we serve. We believe in equal access to quality care and employment opportunities for all.

The hospital is a 171-bed non-profit, community teaching hospital in Jamaica Plain, founded in 1900. It offers comprehensive specialties and is a Magnet-recognized hospital. Our mission is to provide better care and foster a supportive environment for staff and patients alike.

Qualifications:

• High School diploma or GED required.
• 2-3 years experience in insurance authorization, with knowledge of Work Comp, MassHealth, and Medicare preferred.
• Knowledge of EPIC/Cadence/Microsoft Office preferred.
• Participation in staff meetings, in-services, and documentation reviews.
• Ability to perform analytical and decision-making functions with minimal supervision.
• Understanding of hospital and departmental policies.
• Excellent customer service and communication skills.
• Ability to resolve concerns effectively.
• Maintains professionalism in interactions.
• Adheres to all C.A.R.E. Standards.

Additional: Brigham and Women's Faulkner Hospital is an Equal Opportunity Employer. We provide reasonable accommodations for individuals with disabilities during the application and employment process.