Verification & Eligibility Specialist

Site: Brigham and Womens Faulkner Hospital Inc.

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 notforprofit we support patient care research teaching and community service striving to provide exceptional care. We believe that highperforming teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

This is an onsite role.10 hours per week.

Job Summary

The Verification & Eligibility Specialist for Rehabilitation Services performs a variety of authorization referral and eligibility functions related to the hospitals patient account receivable in accordance with the hospitals established policies and procedures government and thirdparty payer requirements and HIPAA and/or presiding regulatory guidelines. Responsible for ensuring all procedures are cleared 48 hours prior to service 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 physicians 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 followup 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 Womens Faulkner Hospital:
Brigham and Womens 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 cuttingedge healthcare and research.

Brigham and Womens Faulkner Hospital is a 171 bed nonprofit community teaching hospital located in Jamaica Plain directly across the street from the Arnold Arboretum. Founded in 1900 Brigham and Womens Faulkner Hospital offers comprehensive care in a wide variety of specialties. Brigham and Womens 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 Womens 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 youre looking for more than a career join Brigham and Womens Faulkner Hospital. Our patients call it better care. Our employees call it home.

• High School diploma or GED required.
• 23 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 inservices 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

Onsite

1133 Centre Street

0

Per Diem

Day (United States of America)

Brigham and Womens Faulkner Hospital Inc. 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 Veterans 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)2827642.

Mass General Brigham Competency Framework