Patient Access & Revenue Cycle Specialist (Patient Financial Services)

• Managing intake, policy implementation, access, and financial clearance activities for the Patient Financial Services Out-of-Network team.
• The specialist will perform the following activities routinely for local, regional, national, and international patients:
  • Obtaining and utilizing accurate demographic and insurance information, ensuring highly reliable eligibility verification and family understanding of what to expect with regard to being considered for services at Boston Children's with their out-of-network health plan.
  • Understanding payer policy rules and the BCH policies that guide clinical acceptance for services.
  • Participating in daily staff huddles to review case questions and issues to support timely actions.
  • Educating staff and providers on payers and financial assessment of risk.
  • Coordination of a checklist of activities for the benefit of patient families and finance pre-service operations, including working with BCH Financial Navigators to ensure every patient has the opportunity to have assistance with insurance options, including obtaining and reviewing estimates and suggesting secondary coverage options if applicable.
  • Supporting financial services representatives in obtaining authorizations, single case agreements, and bundled episodes as needed.
• Ensuring business process documentation in EPIC and other tracking systems to maintain a high-fidelity team.
• Managing highly sensitive patient information and payor interactions, ensuring accuracy and integrity of work product. Engaging with others in a manner that upholds high standards of hospital policies, Human Resources, Finance Operations, Compliance and ISD with high reliability.
• Contributing to a continuous improvement process in PFS, developing scalability and reliability in processes and procedures.
• Maintaining files and key documents for knowledge management of all areas within the scope of out-of-network using the newest tools and technology provided.
• Collaborating effectively across PFS, Payor Relations, Contracting and Financial Counseling to gather insights on patient satisfaction and revenue cycle successes.
• With a high degree of professional presence, attending internal and inter-hospital meetings as a representative of the department, reporting on progress for prospective patients.
• Responsible for contributing to meeting department goals and targets, updating work plans, and other key initiatives of the department.

To qualify, you must have:

• Bachelor's degree or equivalent experience required. Bachelor's degree in business, finance, healthcare administration, public health or a closely related field preferred.
• 2 years' experience in a healthcare related field required.
• Creative and analytical skills to resolve operational and administrative problems, often requiring innovative application of specialized knowledge, root cause analysis, diplomatic and timely resolution of issue in support of the hospital's major departments or divisions.
• Knowledge or ability to rapidly learn navigation of electronic health records and payor platforms to effectively manage accounts in a compliant and efficient manner.
• Ability to effectively partner and negotiate with peers and external payors to effectively adhere to internal operational principles as assigned in teams and independently.
• Ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations.
• Ability to work with diverse internal and external constituencies.

Boston Children's Hospital offers competitive compensation and unmatched benefits. Experience the benefits of passion and teamwork.