Financial Access Specialist

Spaulding Rehabilitation; Boston (MA); Remote; USD 39,000 - 41,000; Full time

Job summary

The Spaulding Rehabilitation Hospital Corporation is seeking a Financial Access Specialist to coordinate and document patient referral information within a centralized unit supporting admissions. You will verify insurance eligibility, determine benefit levels, and communicate financial responsibilities to patients and staff.

You will initiate prior authorizations, negotiate and submit appeals when necessary, and maintain patient and account queues while delivering excellent service to patients,

Qualifications

• High School Diploma or Equivalent required; degree not accepted in lieu of experience.
• 2–3 years of Patient Access/Hospital Registration or Revenue Cycle experience.
• Knowledge of medical terminology, insurance plans, and reimbursement processes.
• Familiarity with HIPAA and patient confidentiality requirements.
• Strong communication and interpersonal skills.
• Attention to detail and accuracy in data entry and documentation.
• Ability to work independently and in a fast-paced team.

Responsibilities

• Coordinate and document patient referral information within Centralized Financial Access.
• Verify insurance benefits and eligibility with carriers and government agencies.
• Obtain prior authorizations for therapy services from managed care companies.
• Maintain patient and account work queues.
• Explain financial responsibilities, estimated costs, and available financial assistance.
• Provide exceptional customer service to patients, families, and visitors.

Skills

Medical terminology

Insurance plans

Reimbursement processes

HIPAA confidentiality

Communication

Attention to detail

Data entry accuracy

Independent work

Education

High School Diploma or Equivalent

Tools

NEHEN

MMIS

Blue Links

Availity

Job description

Site: The Spaulding Rehabilitation Hospital Corporation

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

The Financial Access Specialist is responsible for the smooth coordination and documentation of patient referral information within a Centralized Financial Access unit supporting the admissions flow, for patients referred from multiple sources. Responsible for the verification and documentation of insurance eligibility and benefit levels for pre-determined levels of care and for identifying patient out of pocket payment responsibilities and communicating that information to appropriate parties. Initiates prior authorization, negotiates single and submits appeals, when necessary, to ensure prior authorizations of referred patients are accurate.

Essential Functions

• Takes independent action to ensure all information is obtained and complete so that benefit levels are adequate to ensure reimbursement for the care provided.
• Verifies insurance benefits and eligibility with insurance carriers and government agencies using NEHEN, MMIS, Blue Links, Availity and other means (UHC, THP, ALLWAYS, HPHC portals) to determine level of benefits for each patient referred to the organization.
• Obtains prior authorizations for therapy, PT/OT/SLP from managed care companies via phone, fax, e-fax or electronically via payer specific portals.
• Responsible for maintenance of patient and account work queues.
• Explain the financial responsibilities and obligations to patients, including estimated costs for services and any applicable financial assistance programs.
• Provide exceptional customer service to patients, families, and visitors, addressing their inquiries and concerns promptly and professionally.

Qualifications

Education High School Diploma or Equivalent required Can this role accept experience in lieu of a degree? No Licenses and Credentials Experience Patient Access/Hospital Registration or Revenue Cycle Experience 2-3 years required Knowledge, Skills and Abilities - Knowledge of medical terminology, insurance plans, and reimbursement processes. - Familiarity with healthcare regulations, including HIPAA, and the ability to maintain patient confidentiality. - Excellent communication and interpersonal skills to effectively interact with patients, families, and healthcare professionals. - Strong attention to detail and accuracy in data entry and documentation. - Ability to work independently and as part of a team in a fast-paced environment.

Physical Requirements

• Standing Occasionally (3-33%)
• Walking Occasionally (3-33%)
• Sitting Constantly (67-100%)
• Lifting Occasionalily (3-33%) 20lbs - 35lbs
• Carrying Occasionally (3-33%) 20lbs - 35lbs
• Pushing Rarely (Less than 2%)
• Pulling Rarely (Less than 2%)
• Climbing Rarely (Less than 2%)
• Balancing Occasionally (3-33%)
• Stooping Occasionally (3-33%)
• Kneeling Rarely (Less than 2%)
• Crouching Rarely (Less than 2%)
• Crawling Rarely (Less than 2%)
• Reaching Occasionally (3-33%)
• Gross Manipulation (Handling) Constantly (67-100%)
• Fine Manipulation (Fingering) Frequently (34-66%)
• Feeling Constantly (67-100%)
• Foot Use Rarely (Less than 2%)
• Vision - Far Constantly (67-100%)
• Vision - Near Constantly (67-100%)
• Talking Constantly (67-100%)
• Hearing Constantly (67-100%)

Remote Type

Remote

Work Location

300 First Avenue

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$ - $28.30/Hourly

Grade

3

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

EEO Statement

1400 The Spaulding Rehabilitation Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.