Remote Pre-Certification & Authorization Specialist

Tufts Medicine; United States; A distancia; USD 28.000 - 35.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Total Rewards package

Remote work

Descripción de la vacante

Tufts Medicine is seeking a Remote Patient Access Specialist to support revenue cycle activities including billing, collections, cost estimates, and payment processing. The role also handles demographic data collection, scheduling, and referrals to ensure patients receive recommended services.

The position emphasizes accurate EMR documentation, insurance verification, precertification, and clear communication with patients and providers, in a fully remote environment.

Formación

• High school diploma or equivalent.
• Two years of related experience in a hospital, physician office, or financial services.
• Associate’s degree preferred.
• Five years of related experience in a hospital, physician office, or financial services preferred.

Responsabilidades

• Contacts insurance companies and workers compensation carriers to obtain verification of insurance, eligibility, and benefits.
• Contacts patients for updates of financial and demographic information and ensures timely EMR updates.
• Obtains financial data from multiple sources including in-state/out-of-state payers and uses payer eligibility sites and outreach.
• Arranges for coordination of benefits when multiple insurers are involved.
• Obtains precertification and referrals for procedures and updates the EMR accordingly.
• Identifies non-covered services and communicates financial risk concerns to leadership for resolution.
• Collaborates with Financial Coordination and Pre-Registration to resolve financial risks before services.
• Obtains necessary clinical documentation for payers and submits securely.
• Follows case statuses, documents in hospital system, and monitors productivity and quality.
• Identifies denied claims and works with leaders and teams toward appeals.
• Acts as a resource to other departments on precertification policies and documentation.
• Maintains collaborative relationships to achieve team goals and positive work environment.
• Works with Case Management and Admitting to confirm level of care changes and communicate with payers.
• Learns and adapts to workflow changes and assists in training new members.

Conocimientos

Medical terminology

ICD-10 coding

CPT coding

Insurance payer knowledge

Precertification processes

EMR systems

Microsoft Word/Excel

Communication skills

Organization

Teamwork

Educación

High school diploma or equivalent

Associate’s degree

Herramientas

EMR system

Microsoft Word

Microsoft Excel

Descripción del empleo

Tufts Medicine is seeking a Remote Patient Access Specialist to support revenue cycle activities including billing, collections, cost estimates, and payment processing. The role also handles demographic data collection, scheduling, and referrals to ensure patients receive recommended services.

The position emphasizes accurate EMR documentation, insurance verification, precertification, and clear communication with patients and providers, in a fully remote environment.