Pre-Service Center Verification Specialist

POSITION SUMMARY

The Pre Service Center (PSC) Verification Specialist role belongs to the Revenue Cycle Patient Access team and is responsible for coordinating all financial clearance activities by navigating all pre-registration (to include acquiring or validating patient demographic, insurance, and other required elements along with insurance verification activities), obtaining referral authorization, or precertification number(s), pre-service cash collections. The role ensures timely access to care while maximizing BMC hospital reimbursement.

This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. This position reports to the Pre Service Center Supervisor and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, Boston Medical Center (BMC) practice staff, case management and Patient Financial Counseling.

This is a Remote Position.

Pre-Service Center Verification Specialist

Ambulatory

Full

• 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 online databases, electronic correspondence, faxes, and phone calls.
• Obtains and clearly documents all referral/prior authorization 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…