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Beth Israel Lahey Health Financial Clearance Specialist - Neurology MAPS - 40 Hours - Day Shift in Cambridge, Massachusetts

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Performs a variety of functions to support an accurate, safe and customer-focused patient access process. Ensures that all proper patient financial and demographic information is obtained and processed so Mount Auburn Hospital (MAH) is fully reimbursed for clinical services provided. Handles patient questions and requests accurately and efficiently, ideally with first call resolution, or by making appropriate referrals to other departments, based on the original purpose of the question and any other questions or requests subsequently disclosed by the patient. Ensures that the patient experience in accessing healthcare at MAH is efficient and welcoming, and that patient confidentiality is respected and patient safety is preserved.

Job Description:

Primary Responsibilities (including but not limited to):

  • Registers patients presenting for visits.  Explains the registration process to patients and responds to patient questions.

  • Processes patient co-payments, co-insurance, deductibles and balances due. Safeguards cash, checks and receipts and reconciles cash drawer at end of each business day. Assists patients with Kiosk check-in as needed.

  • Completes the Medicare Secondary Payer Questionnaire for each patient and adjusts patient coverage based on results.

  • Instructs patients and obtains signatures on consent forms, financial forms and other documents required by the clinical department; distributes documents to patients; scans, processes and records receipt of all documents collected during registration encounter.

  • Counsels patients regarding non-covered services, obtaining signatures on Advance Notice Beneficiaries (ABNs), consents and waivers.

  • Monitors patient waiting area for a smooth, efficient registration flow. Advises patients of potential delays and takes steps to ensure a pleasant patient experience.  

  • Completes registrations on inpatient units who may be missing information from their original registration

  • Responds to patient concerns and potential patient safety issues accordingly. Recognizes health conditions that are a possible risk to others and adheres to appropriate established procedures to help contain risk.

  • Assures a neat, orderly registration desk and patient waiting area, securing all confidential patient information.

  • Identifies payer medical necessity determination before services are rendered. Informs departments of failed instances. When circumstances dictate, requests additional information to re-run medical necessity check. (essential)

  •  Determines authorization requirement and, when necessary, obtains authorization from payer by utilizing payer specific protocols. Requests and coordinates any additional information from departments when needed. (essential)

  •  Identifies and escalates issues timely and appropriately for resolution and communicates and coordinates with revenue cycle peers, leadership and clinical stakeholders. Documents interim and final results in appropriate systems. (essential)

  •  Completes assigned work queues and reports daily to achieve standards of productivity and quality. Assists with reviewing medical necessity and obtaining authorization for urgent or walk-in visits. Refers patients to financial counselors to resolve complex financial issues and/or inquiries. (essential)

  •  Follows Mt. Auburn Hospital and BIDMC policies, procedures and training materials to ensure compliance to federal, state, and contractual requirements. (essential)

  •  Identifies trends and provides periodic reports to departments on operational, productivity, and quality metrics. (essential)

  •  Performs other activities on an as-needed basis to support the department. (essential)

  • Initiates patient scheduling activities by prioritizing and accessing a variety of sources, including patient phone calls and digital messaging, orders, scheduled order work queues and MyChart.

  • Utilizes a variety of information sources to schedule, reschedule and cancel patient appointments. Information sources include online questionnaires, offline materials and subgroup searches.  

  • Establishes working relationship with staff of assigned clinical departments. Understands and correctly applies unique clinical department scheduling protocols.  

  • Remains current on scheduling protocols and applies judgment, or seeks management assistance, to ensure safe patient care when clinical department scheduling protocols do not meet patient needs.

  • Ensures all required key patient scheduling and registration information is captured and verified.  Key information includes referring physician information, insurance coverage, demographics and contact information.   6.    Identifies and communicates to Patient Access management issues that may impact the timeliness and accuracy of patient appointments and subsequent patient care.

  • Strictly follows confidentiality and equipment security and safeguarding guidelines when working in a remote setting.  Maintains productivity, quality and accuracy levels and communicates regularly with the Supervisor and Manager.

  • Pre-Registration:

  • Efficiently registers patients, capturing and verifying all required information in order to identify the patient, contact the patient, and receive proper reimbursement for services on initial claim submission.

  • Ascertains, creates and assigns the guarantor for each patient, including personal/family relations, worker’s compensation insurance, third parties, behavioral health or others as required. 

  • Identifies records and verifies patient insurance coverage using real time eligibility (RTE); reviews the insurer’s response to each verification request and takes appropriate action based on this response.

  • Applies the appropriate guarantor and insurance to each patient visit.

  • Communicates financial clearance status to patients.  Advises patients of contract status, self-pay status and payment responsibility and schedules patients with Financial Counseling as needed.

  • Maintain strict adherence to the Mount Auburn Hospital (MAH) Confidentiality policy.

  • Incorporate MAH Standards of Behavior and Guiding Principles into daily activities.

  • Comply with all MAH Policies.

  • Comply with behavioral expectations of the department and MAH.

  • Maintain courteous and effective interactions with colleagues and patients.

  • Demonstrate an understanding of the job description, performance expectations, and competency assessment.

  • Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.

  • Participate in departmental and/or interdepartmental quality improvement activities.  

  • Participate in and successfully completes

  • Mandatory Education. 

  •  Perform all other duties as needed or directed to meet the needs of the department.

*Required Qualifications: *

  • Identifies payer medical necessity determination before services are rendered. Informs departments of failed instances. When circumstances dictate, requests additional information to re-run medical necessity check. (essential)

  • Determines authorization requirement and, when necessary, obtains authorization from payer by utilizing payer specific protocols. Requests and coordinates any additional information from departments when needed. (essential)

  • Identifies and escalates issues timely and appropriately for resolution and communicates and coordinates with revenue cycle peers, leadership and clinical stakeholders. Documents interim and final results in appropriate systems. (essential)

  • Completes assigned work queues and reports daily to achieve standards of productivity and quality. Assists with reviewing medical necessity and obtaining authorization for urgent or walk-in visits. Refers patients to financial counselors to resolve complex financial issues and/or inquiries. (essential)

  • Follows Mt. Auburn Hospital and BIDMC policies, procedures and training materials to ensure compliance to federal, state, and contractual requirements. (essential)

  • Identifies trends and provides periodic reports to departments on operational, productivity, and quality metrics. (essential)

  • Performs other activities on an as-needed basis to support the department. (essential)

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.

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Equal Opportunity Employer/Veterans/Disabled

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