Financial Access Specialist

Under the direction of the Patient Access Manager, the Financial Access Specialist is responsible for financial clearance of assigned post-acute admissions within the Financial Access Department, supporting inpatient Acute Rehabilitation (IRF), Long Term Acute Care (LTAC), and Skilled Nursing Facility (SNF) levels of care across Spaulding Rehabilitation facilities. This role verifies insurance eligibility, coverage, and benefits, and manages prior authorizations from initiation through final determination.

The Financial Access Specialist ensures accurate documentation within Epic and works collaboratively with Admissions, Case Management, Financial Counseling, leadership, and other departments to ensure timely admissions and financial accountability aligned with organizational goals and system-wide objectives.

• Responsible for financial clearance of assigned post-acute admissions, including verification of insurance eligibility, coverage, and benefits.
• Initiates and manages prior authorization requests from submission through final determination. This includes submitting required clinical documentation, conducting routine status checks through payer portals and direct communication with payers, confirming admission and authorization details with payers when applicable, and ensuring timely progression of each case.
• Ensures all authorization activity is thoroughly documented in Epic (Auth/Cert), providing visibility across departments and supporting accurate reimbursement.
• Identifies benefit limitations, network concerns, out-of-network scenarios, and other financial risks, escalating to the Patient Access Manager or Financial Counselor when appropriate.
• Negotiates single case agreements with Workers’ Compensation carriers and non-contracted payers as needed, including preparation of cost estimates and participation in reimbursement discussions to secure appropriate payment terms.
• Responsible for monitoring and prioritizing assigned Epic Work queues to support time-sensitive admissions and maintain efficient referral throughput.
• Communicates authorization updates, insurance requests for additional information, peer-to-peer offers, appeals, and denials to Admissions and other relevant stakeholders.
• Maintains and resolves errors and required edits within Epic Patient and Account Work queues, including pre-admission, admitted, and discharged encounters, to ensure account accuracy and appropriate reimbursement.
• Prepares self-pay cost estimates when applicable and collaborates with Financial Counseling to ensure financial clearance prior to admission.
• Accurately records authorization determinations and approval details to support Case Management with continued stay and utilization review activities.
• Works collaboratively with Admissions, Case Management, Financial Counseling, and leadership to support timely and financially appropriate admissions.

High School Diploma or equivalent required Bachelor's degree preferred

2+ years of experience required in patient access/hospital registration or revenue cycle Epic experience is strongly preferred Experience with prior authorizations and insurance verifications, eligibility and coverage strongly preferred (inpatient or post‑acute experience)

Knowledge of medical terminology, insurance plans, and reimbursement processes. Familiarity with healthcare regulations, including HIPAA, and the ability to maintain patient confidentiality. Excellent communication and interpersonal skills to effectively interact with patients, families, and healthcare professionals. Strong attention to detail and organizational skills to manage multiple requests effectively. Ability to work independently and…