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 & Schedule
Verifies accuracy of order and scheduled appointment details, updates information as required
Confirms accuracy of patient demographics, insurance information and ordering provider details
Ensures all other elements of order are appropriate by using various internal and external verification systems and department resources
Authorization
Obtains authorization for diagnostic imaging tests via insurance portals and/or fully supports ordering practice in doing so prior to patient appointment
Ensures accuracy of all information conveyed in authorization request and addresses errors in a timely fashion
Gains expertise in insurance requirements and authorization workflows
Develops information networks and personal relationships to maximize effectiveness
Manages numerous authorization requests concurrently without impacting quality
Meets management targets for authorization volume and accuracy rates
Result Monitoring & Tracking
Employs validation techniques to maximize authorization attainment rates
Supports process improvement initiatives, proactively engages supervisor
Actively addresses service enhancement opportunities
Ensures all "hand-offs" among colleagues are clearly communicated and mutually agreed upon
Other
Provides cross-coverage as required
Perform all other related duties appropriate to this level of position and/or as directed by the manager
Observes Hospital and Department policies and procedures at all times
Maintains the confidentiality and privacy of protected health information consistent with HIPAA requirements at all times
Qualifications
SKILLS & COMPETENCIES REQUIRED:
Time Management
Proven ability to prioritize and multi-task in a busy environment
Ability to identify emergent situations, formulate solutions, and take appropriate action in a timely manner and with minimum direction from supervisor
Attentiveness to Detail
Strives for accuracy and completeness in all tasks and at all times
Continually adjusts and improves processes to achieve better results
Holds self directly accountable for gaining and maintaining job domain expertise
Communication
Strives to clearly summarize and communicate critical information at all times
Assesses customer interactions, both internal and external, and provides personalized communication to achieve best outcome
Employs appropriate pace, tone and clarity in all customer interactions
Promptly and appropriately escalates issues and service failures that cannot be resolved independently
Customer Orientation
Recognizes opportunities to provide superior service
Unyielding passion for customer care
Remains calm under pressure while demonstrating a positive attitude and empathy
Strives to maintain highest service standards at all times and with minimal supervision
Goal Oriented Focus
Understands critical success factors of role and orients self to goals
Cares deeply about positive customer outcomes and business results
Continually strives for service excellence
Flexibility
Ability to deal effectively and courteously with a diverse group of internal and external stakeholders
Willingness to be flexible in working hours and location when needed
Ability to work effectively in a team environment
Willingness to learn
Eagerness to master job tasks
Quickly learns and maintains knowledge of the following critical knowledge elements:
Medical terminology
CPT and Diagnosis Codes
Insurance authorization policies and procedures
Epic-ADT referral management processes and procedures
Payment denial and claims support
EDUCATION:
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.
