Remote Insurance Verification & Authorization Specialist

BMC Company 100; United States; Remote; USD 25,000 - 33,000; Full time

Job summary

Boston Medical Center is seeking a Remote Pre Service Center (PSC) Verification Specialist to support the Revenue Cycle Patient Access team. The role coordinates all financial clearance activities, validates patient demographics, insurance, referrals, and pre-service payments to enable timely access to care.

You will collaborate with insurance companies, physicians, and clinic staff, uphold QA and productivity standards, and document authorizations within the Epic environment.

Responsibilities

• Monitors accounts routed to registration, referral and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines.
• Maintains knowledge of and complies with insurance companies' requirements for obtaining prior authorizations/referrals, and completes other activities to facilitate all aspects of financial clearance.
• Acts as subject matter experts in navigating both the BMC and payer policies to get the appropriate approvals (authorizations, pre-certs, referrals, for example) for the scheduled care to proceed. The PSC Verification Specialist is an important part of the larger patient care team and helps clinicians understand what payer requirements are necessary for the widest possible patient access to services.
• Supports BMC staff at all levels for hands‑on help understanding and navigating financial clearance issues.
• Uses appropriate strategies to underscore the most efficient process to obtaining insurance verification, authorizations and referrals, including on line databases, electronic correspondence, faxes, and phone calls.
• Obtains and clearly documents all referral/prior authorizations for scheduled services prior to admission within the Epic environment.
• Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients and any other parties to ensure that required managed care referrals and prior authorizations for specified specialty visits and other services are obtained and appropriately recorded in the relevant practice management systems for patient appointments/visits prior to scheduled patient visits or retro‑actively if not in place at the time of the appointment/visit. Ensure that approval numbers are appropriately linked to the relevant patient appointment/visit.
• When it is determined that a valid referral does not exist, utilize computer‑based tools or contact the appropriate party to obtain/generate referral/authorization and related information. Record the referral/authorization in the practice management system.
• Contact internal and external primary care physicians to obtain referral/authorization numbers.
• Perform follow‑up activities indicated by relevant management reports and WQ's.
• Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients' scheduled services.
• Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations.
• Work collaboratively with the practices to resolve registration, insurance verification, referral or authorization issue to the extent that these unresolved issues impact the ability to obtain a referral/authorization.
• Escalates accounts that have been denied or will not be financially cleared as outlined by department policy.
• Interview patients, families or referring physicians via telephone in advance of the patient's appointment/visit whenever possible, to obtain all necessary information, including but not limited to, financial and demographic information required for reimbursement and compliance for services rendered.
• Accept registration updates from various intake points, including but not limited to those received via paper forms, internet registration forms, telephones located in practices and direct calls from patients.
• Ensure that all updated demographic and insurance information is accurately recorded in the appropriate registration systems for primary, secondary and tertiary insurances.
• Review all registration and insurance information in systems and

Job description

Boston Medical Center is seeking a Remote Pre Service Center (PSC) Verification Specialist to support the Revenue Cycle Patient Access team. The role coordinates all financial clearance activities, validates patient demographics, insurance, referrals, and pre-service payments to enable timely access to care.

You will collaborate with insurance companies, physicians, and clinic staff, uphold QA and productivity standards, and document authorizations within the Epic environment.