At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.
Job Summary
SummaryThe Financial Access Specialist is responsible for the smooth coordination and documentation of patient referral information within a Centralized Financial Access unit obtaining prior authorizations. Responsible for the verification and documentation of insurance eligibility and benefit levels for pre-determined levels of care and for identifying patient out of pocket payment responsibilities and communicating that information to appropriate parties. Initiates prior authorization, negotiates single case agreements, creates self-pay estimates, and submits appeals, when necessary, to ensure prior authorizations are accurate.
Does this position require Patient Care? No
Essential Functions
-Coordinates the prioritization of Financial/Insurance Access to facilitate and expedient prior authorization.
-Takes independent action to ensure all information is obtained and complete so that benefit levels are adequate to ensure reimbursement for the care provided.
-Verifies insurance benefits and eligibility with insurance carriers and government agencies using NEHEN, MMIS, Blue Links, Availity and other means (UHC, THP, MGB, HPHC portals) to determine level of benefits for each patient referred to the organization.
-Obtains prior authorizations from managed care companies via phone, fax, e-fax or electronically via payer specific portals.
-Responsible for maintenance of patient and account work queues.
-Explain the financial responsibilities and obligations to patients, including estimated costs for services and any applicable financial assistance programs.
-Provide exceptional customer service to patients, families, and visitors, addressing their inquiries and concerns promptly and professionally.
Qualifications
Education
High School Diploma or Equivalent required
Can this role accept experience in lieu of a degree?
No
Licenses and Credentials
Experience
Patient Access/Hospital Registration or Revenue Cycle Experience 2-3 years required
Knowledge, Skills and Abilities
- 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 accuracy in data entry and documentation.
- Ability to work independently and as part of a team in a fast-paced environment.
Additional Job Details (if applicable)
Physical Requirements
Standing Occasionally (3-33%)Walking Occasionally (3-33%)Sitting Constantly (67-100%)Lifting Occasionally (3-33%) 20lbs - 35lbsCarrying Occasionally (3-33%) 20lbs - 35lbsPushing Rarely (Less than 2%)Pulling Rarely (Less than 2%)Climbing Rarely (Less than 2%)Balancing Occasionally (3-33%)Stooping Occasionally (3-33%)Kneeling Rarely (Less than 2%)Crouching Rarely (Less than 2%)Crawling Rarely (Less than 2%)Reaching Occasionally (3-33%)Gross Manipulation (Handling) Constantly (67-100%)Fine Manipulation (Fingering) Frequently (34-66%)Feeling Constantly (67-100%)Foot Use Rarely (Less than 2%)Vision - Far Constantly (67-100%)Vision - Near Constantly (67-100%)Talking Constantly (67-100%)Hearing Constantly (67-100%)
Remote Type
Remote
Work Location
300 First Avenue
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
The Spaulding Rehabilitation Hospital Corporation is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.