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Job Summary
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.
Essential Functions
- 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 Workqueues 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 Workqueues, 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.
Education
Experience
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, 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 organizational skills to manage multiple requests effectively.
Ability to work independently and as part of a team in a fast-paced environment.
Working Schedule:
Remote, requires a quiet, secure, HIPAA-compliant work station
Occasional weekends required (one Saturday shift 10am - 2pm monthly, subject to change)
Additional Job Details (if applicable)
Remote
399 Revolution Drive
40
Regular
Day (United States of America)
Pay Range
$21.00 - $28.30/Hourly
Grade
3
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
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.