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Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
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Job Summary
This position is primarily responsible for working collaboratively with practices, physicians, and patients to ensure that required authorizations and referrals for ancillary hospital departments have been obtained and appropriately recorded in Epic's authorization and referral management systems. The role is also responsible for researching updated insurance medically necessary policies related to ancillary exams, which includes research and appeals of any ancillary department denials.
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Qualifications
Minimum Requirements:
High School Diploma or Equivalent required
Associate's degree in healthcare administration preferred
Experience in a healthcare or hospital setting, with a focus on patient services, registration, admissions, or insurance verification. 2-3 years required
Knowledge, Skills and Abilities:
Strong organizational and time management skills with attention to detail.
Excellent communication and interpersonal skills, with the ability to interact effectively with patients, healthcare providers, and insurance representatives.
Proficiency in healthcare management software, EPIC experience, electronic health records (EHR), and Microsoft Office Suite (Word, Excel).
Knowledge of insurance processes, pre-authorization procedures, and healthcare regulations.
Ability to handle sensitive information with discretion and maintain confidentiality.
Familiarity with and understanding of all major health insurers and all insurance benefit coverage issues required
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Additional Job Details (if applicable)
Shift: Monday - Friday 10:00AM -2:00PM
* Hybrid schedule after successfully completing on-site training
Key Roles & Responsibilities:
Oversee and manage the pre-service process, obtain/generate/validate authorizations and insurance referrals.
Primarily responsible for working collaboratively with Mass General Brigham practices to obtain authorizations and insurance referrals for services prior to scheduled visits by effectively communicating with payers to submit, track, follow up, and obtain insurance referrals in a timely manner.
Responsible for documenting and tracking the number of referrals/authorizations that are deferred, generated and obtained.
Following up with practices who do not immediately issue an insurance referral or obtain the appropriate authorizations, noting the reason for the delay and documenting when services are denied.
Interfacing with practices and patients to report referral/authorization information.
Complying with Pre Service standards for productivity, accuracy, quality and customer service.
Ensure that all pre-service documentation is completed accurately and submitted in a timely manner.
Verify and update patient insurance benefits and coverage for scheduled procedures or admissions.
Ensure that patients receive clear instructions and necessary information regarding their pre-service requirements and appointment preparations.
Provide excellent customer service by addressing patient inquiries, concerns, and requests related to their pre-service requirements.
Serve as a resource to providers, support staff and patients regarding the referral and authorization process; research questions thoroughly and assists with interpretation of health plan guidelines.
Works EPIC work queues to review billing rejections and resolve insurance issues to maximize reimbursement.
This includes, but is not limited to, obtaining retroactive referral and authorization numbers for bills that were denied for no referral or no authorization.
Perform insurance medical necessity checks as outlined by departmental policy and procedures and advise the physicianās office if additional diagnostic information is required.
Advise the patient of ABN requirements if the medical necessity does not pass and obtain the cost for such service.
Performs other duties as assigned Complies with all policies and standards.
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Remote Type
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Work Location
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Scheduled Weekly Hours
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Employee Type
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Work Shift
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Pay Range
$22.22 - $31.71/Hourly
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Grade
4
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EEO Statement:
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At Mass General Brigham, our competency framework defines what effective leadership ālooks likeā 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.
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