Financial Access Specialist
Job Location:
Somerville, NJ - USA
Hourly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
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.
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.
Qualifications
Education
High School Diploma or equivalent required
Bachelors degree preferred
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 Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$21.00 - $28.30/HourlyGrade
3EEO Statement:
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.
Required Experience:
IC
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
