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 & ScheduleVerifies accuracy of order and scheduled appointment details, updates information as requiredConfirms accuracy of patient demographics, insurance information and ordering provider detailsEnsures all other elements of order are appropriate by using various internal and external verification systems and department resources AuthorizationObtains authorization for diagnostic imaging tests via insurance portals and/or fully supports ordering practice in doing so prior to patient appointmentEnsures accuracy of all information conveyed in authorization request and addresses errors in a timely fashionGains expertise in insurance requirements and authorization workflowsDevelops information networks and personal relationships to maximize effectivenessManages numerous authorization requests concurrently without impacting qualityMeets management targets for authorization volume and accuracy ratesResult Monitoring & TrackingEmploys validation techniques to maximize authorization attainment ratesSupports process improvement initiatives, proactively engages supervisorActively addresses service enhancement opportunitiesEnsures all "hand-offs" among colleagues are clearly communicated and mutually agreed upon OtherProvides cross-coverage as requiredPerform all other related duties appropriate to this level of position and/or as directed by the managerObserves Hospital and Department policies and procedures at all timesMaintains the confidentiality and privacy of protected health information consistent with HIPAA requirements at all timesQualifications SKILLS & COMPETENCIES REQUIRED:
Time ManagementProven ability to prioritize and multi-task in a busy environmentAbility to identify emergent situations, formulate solutions, and take appropriate action in a timely manner and with minimum direction from supervisor Attentiveness to DetailStrives for accuracy and completeness in all tasks and at all timesContinually adjusts and improves processes to achieve better resultsHolds self directly accountable for gaining and maintaining job domain expertise Communication Strives to clearly summarize and communicate critical information at all timesAssesses customer interactions, both internal and external, and provides personalized communication to achieve best outcomeEmploys appropriate pace, tone and clarity in all customer interactionsPromptly and appropriately escalates issues and service failures that cannot be resolved independently Customer OrientationRecognizes opportunities to provide superior serviceUnyielding passion for customer careRemains calm under pressure while demonstrating a positive attitude and empathyStrives to maintain highest service standards at all times and with minimal supervision Goal Oriented FocusUnderstands critical success factors of role and orients self to goalsCares deeply about positive customer outcomes and business resultsContinually strives for service excellence FlexibilityAbility to deal effectively and courteously with a diverse group of internal and external stakeholdersWillingness to be flexible in working hours and location when needed Ability to work effectively in a team environment Willingness to learnEagerness to master job tasksQuickly learns and maintains knowledge of the following critical knowledge elements:Medical terminologyCPT and Diagnosis CodesInsurance authorization policies and proceduresEpic-ADT referral management processes and proceduresPayment denial and claims supportEDUCATION:
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.
