Financial Clearance Specialist I - 90 days onsite and Remote After Successful Training
Massachusetts General Hospital(MGH)

GENERAL SUMMARY/ OVERVIEW STATEMENT:

Under general supervision of the Financial Clearance Manager, the Financial Clearance Specialist I functions as primary interface between MGH Imaging, MGH Patient Service Center, insurance companies, patients, and referring practices. In incumbent performs all tasks related to obtaining insurance authorizations for diagnostic imaging tests - primarily in Epic system - and has direct accountability for authorization related financial outcomes, participates in performance tracking and service improvement initiatives.

Monday-Friday 8:30am to 5:00pm

90 days on-site and remote after successful Training

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Order & Schedule

Verifies accuracy of order and scheduled appointment details, updates information as required

Confirms accuracy of patient demographics, insurance information and ordering provider details

Ensures all other elements of order are appropriate by using various internal and external verification systems and department resources

Authorization

Obtains authorization for diagnostic imaging tests via insurance portals and/or fully supports ordering practice in doing so prior to patient appointment

Ensures accuracy of all information conveyed in authorization request and addresses errors in a timely fashion

Gains expertise in insurance requirements and authorization workflows

Develops information networks and personal relationships to maximize effectiveness

Manages numerous authorization requests concurrently without impacting quality

Meets management targets for authorization volume and accuracy rates

Result Monitoring & Tracking

Employs validation techniques to maximize authorization attainment rates

Supports process improvement initiatives, proactively engages supervisor

Actively addresses service enhancement opportunities

Ensures all "hand-offs" among colleagues are clearly communicated and mutually agreed upon

Other

Provides cross-coverage as required

Perform all other related duties appropriate to this level of position and/or as directed by the manager

Observes Hospital and Department policies and procedures at all times

Maintains the confidentiality and privacy of protected health information consistent with HIPAA requirements at all times

Qualifications
SKILLS & COMPETENCIES REQUIRED:

Time Management

Proven ability to prioritize and multi-task in a busy environment

Ability to identify emergent situations, formulate solutions, and take appropriate action in a timely manner and with minimum direction from supervisor

Attentiveness to Detail

Strives for accuracy and completeness in all tasks and at all times

Continually adjusts and improves processes to achieve better results

Holds self directly accountable for gaining and maintaining job domain expertise

Communication

Strives to clearly summarize and communicate critical information at all times

Assesses customer interactions, both internal and external, and provides personalized communication to achieve best outcome

Employs appropriate pace, tone and clarity in all customer interactions

Promptly and appropriately escalates issues and service failures that cannot be resolved independently

Customer Orientation

Recognizes opportunities to provide superior service

Unyielding passion for customer care

Remains calm under pressure while demonstrating a positive attitude and empathy

Strives to maintain highest service standards at all times and with minimal supervision

Goal Oriented Focus

Understands critical success factors of role and orients self to goals

Cares deeply about positive customer outcomes and business results

Continually strives for service excellence

Flexibility

Ability to deal effectively and courteously with a diverse group of internal and external stakeholders

Willingness to be flexible in working hours and location when needed

Ability to work effectively in a team environment

Willingness to learn

Eagerness to master job tasks

Quickly learns and maintains knowledge of the following critical knowledge elements:

Medical terminology

CPT and Diagnosis Codes

Insurance authorization policies and procedures

Epic-ADT referral management processes and procedures

Payment denial and claims support

EDUCATION:

Minimum Required:

High school diploma, GED or equivalent

EXPERIENCE:

Preferred: 1 year of administrative experience, preferably in a clinical setting. Prior work experience utilizing computers and pertinent office equipment.

EEO Statement
Massachusetts General Hospital 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.

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