Senior Patient Finance Representative - Cardiac Surgery
Boston Children's Hospital
Location: Boston, Massachusetts
Internal Number: 3240730
Senior Patient Financial Clearance Representative in Cardiac Surgery is responsible to:
Manage daily assignments using standardized protocols and SPS Dashboard/Second Opinion Portal to ensure timely completion of financial clearance in accordance with departmental processes and payer guidelines
Collect, verify, and record all demographic information required for patient financial clearance to include preparing the families for potential obstacles
Verify insurance eligibility utilizing available technologies, payer websites, or by phone contact with third party payers. Work in accordance with required State and Federal regulations and hospital policies
Ensure that correct insurance company name, address, plan, and filing order are recorded in the patient accounting system
Use payer exception reports to update coverage/PCP information
Contact PCP (primary care physician) offices to secure referrals and enter referrals into patient accounting system
Collaborate with clinical depts, case managers and clinical liaison to ensure documentation secured and scanned in the BCH MR, Letters of Medical Necessity secured (internal and OSH) and authorization in place
Proactively engage patients and family members to determine coverage limitations and financial liability
Communicate with physician offices, service sites and ancillary depts if referrals/authorizations are denied at least 72 hours prior to service date
Facilitates peer to peer reviews when needed to secure authorizations
Document all actions taken on accounts with clear and concise account notes
Participate in process improvement activities
To qualify you must have:
The completion of High School Diploma is required and min of 1 year direct experience working with health insurance, referrals and authorizations. A Bachelor's degree preferred.
Understanding of Microsoft Office and experience with Epic registration system a plus
The ability to communicate effectively both orally and in writing
The ability to resolve complex problems requiring the use of critical thinking skills and scientific, mathematical, or technical principles.
Effective organizational skills and the ability to work in a fast-paced environment to ensure completion of assignments within established periods
Attention to detail and completion of tasks with accuracy
CPC-A, CPB, CRC and or CPC, registration or licensure is preferred
Boston Children's Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, cell phone plan discounts and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.