Verification & Eligibility Specialist

Brigham & Women's Faulkner Hospital
United States, Massachusetts, Boston
1133 Centre Street (Show on map)
Jan 01, 2025
The Verification & Eligibility Specialist for Rehabilitation Services performs a variety of authorization, referral and eligibility functions related to the hospital's patient account receivable in accordance with the hospital's established policies and procedures, government and third-party payer requirements, and HIPAA and/or presiding regulatory guidelines. Responsible for ensuring all procedures are cleared 48 hours prior to service date.Coordinates activities with both internal and external customers. -Ensures that proper insurance, plan choice, prioritization and billing address are assigned in the system. -Updates accurate demographic information for the patient, guarantor and subscriber. -Documents all actions taken on account(s) with complete and accurate notes. -Contacts third party and/or government payers to verify and obtain patient eligibility, authorization referral status. -Performs duties electronically. -Uses phone only when necessary. -Demonstrates an excellent understanding of authorization and referral needs based on payer and service. -Communicates effectively with multiple internal and external sources in order to elicit information pertinent to the resolution or adjudication of claim(s) via verbal and/or written correspondence. -Informs department supervisor and/or manager of internal or external matters and issues that may impact payment of services provided. Contributes to problem solving efforts to resolve issues through feedback, information and research. -Demonstrates thorough working knowledge MediTech functionality necessary to perform updates and document all information required. -Demonstrates an excellent working knowledge of payer web sites, NEHEN and clearing houses (Emdeon). Performs all duties using electronic -Collaborates with Collections regarding the status of authorizations. Provides documentation needed for appeals. -Contacts patients, service area and/or physician's offices with issues that may affect payments of claim for services provided. -Ensures that accounts are cleared for service 7 days to 48 hours prior to service date. -Performs consistent follow-up on assigned reminders and reports to ensure accurate completion within timeframes set by the department. -Maintains patient privacy and confidentiality in accordance with HIPAA requirements. -Other duties as assigned. About Brigham and Women's Faulkner Hospital: Brigham and Women's Faulkner Hospital, an affiliate of 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 in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender identity, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research. Brigham and Women's Faulkner Hospital is a 171- bed non-profit, community teaching hospital located in Jamaica Plain directly across the street from the Arnold Arboretum. Founded in 1900, Brigham and Women's Faulkner Hospital offers comprehensive care in a wide variety of specialties. Brigham and Women's Faulkner Hospital is a designated Magnet hospital by the American Nurses Credentialing Center, a recognition that fewer than nine percent of all US hospitals receive. At Brigham and Women's Faulkner Hospital, we believe that everyone should have the chance to live a healthy life. From creating breakthroughs that have paved the way for treatments around the globe to training the next generation of providers, our patients, and those we may never meet, are at the center of everything we do. If you're looking for more than a career, join Brigham and Women's Faulkner Hospital. Our patients call it better care. Our employees call it home. High School diploma or GED required. 2-3 years experience in performance of insurance authorization with understanding of Work Comp, Mass Health, and Medicare preferred. Knowledge of EPIC/Cadence/Microsoft Office preferred. Attends and participates in staff meetings, in-services, and reviews documentation as required. Performs analytical and decision making functions with minimal supervision; recognizes and seeks assistance when necessary. Demonstrates understanding of relative Hospital and departmental policies or procedures Demonstrates excellent customer service and listening skills; treats patients with courtesy, respect and compassion. Strives to resolve concerns when they arise. Maintains professional composure when interacting with staff, other departments, patients, visitors, etc. Adheres to all C.A.R.E. Standards Additional Job Description Brigham and Women's Faulkner Hospital, Inc. is an Equal Opportunity 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.