Senior Patient Finance Representative (Patient Financial Services)

Position Summary:
Ensures all required demographic, insurance, referral and authorization data is collected, verified, entered and communicated appropriately. Coordinates activities with physician offices, service sites, ancillary departments, case managers and insurance representatives to proactively complete financial preprocessing of patients. Handles financial preprocessing for the full range of hospital services, including outpatient appointments, inpatient, day surgery and observation encounters. Proactively engages patients and family members to determine coverage limitations and financial liability. Identifies trends, denials, issues impacting account resolution or workload, and refers as appropriate. Maintains a basic understanding of 3rd party payer contracts as well as a working knowledge of payer referral and authorization requirements.

Key Responsibilities:

• Manages daily assignments using standardized protocols and work queues to ensure timely completion of financial clearance in accordance with departmental processes and payer guidelines.
• Collects, verifies, and records all demographic information required for patient financial clearance in accordance with hospital policy. Verifies insurance eligibility utilizing available technologies, payer websites, or by phone contact with third party payers. Works in accordance with required State and Federal regulations and hospital policies. Ensures that correct insurance company name, address, plan, and filing order are recorded in the patient accounting system.
• Uses payer exception reports to update coverage / PCP information. Contacts PCP (primary care physician) offices to secure referrals and enter referrals into patient accounting system. Communicates with physician offices, service sites and ancillary departments if referrals/authorizations are denied at least 72 hours prior to service date.
• Collaborates with clinical departments, case managers and clinical liaison to ensure payer authorizations are obtained timely.
• Proactively engages patients and family members to determine coverage limitations and financial liability.
• Facilitates peer to peer reviews when needed to secure authorizations. Documents all actions taken on accounts with clear and concise account notes.
• Participates in process improvement activities.

• High School Diploma/GED required

• 1 year of direct experience working with health insurance, referrals, and authorizations.

The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.