Insurance/Authorization Review

Site: Newton-Wellesley Hospital 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 Financial Coordinator Supervisor, ensures that all information necessary for proper financial reimbursement for high dollar patient care is analyzed and submitted to insurance companies for approval prior to the patient’s date of service. Collaborates with insurance companies and physician offices when necessary to verify eligibility and authorization requirements to ensure financial reimbursement for services. Perform all insurance verification for eligibility, coverage, and authorization requirements via Web or phone with third party payers. Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validates that coverages are assigned to appropriate visit. -Collects and validates order-related information including office visit, radiology and surgical orders. Follows up with ordering provider to verify CPT codes. Escalates challenging accounts to team lead to ensure accounts are approved at prior to patient appointment/surgery. Escalates non-certified urgent cases to appropriate clinical departments and leadership for approval to proceed or communicate rescheduling. Contacts providers and insurance companies to validate data, collect missing information and resolve information discrepancies, -Understands clinical guidelines for payors requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes. Work closely with physician offices obtaining authorization for inpatient and outpatient services Work collaboratively with Case Management for all patients’ financial issues and updating accounts.

Qualifications

Education High school graduate or equivalent; some college preferred Experience 1-2 years of insurance, third party payor or secretarial experience in a health care setting required Knowledge and Skills Medical Terminology required Analytical ability to gather and interpret data and communicate desired outcomes orally and in writing in a professional manner Strong communication and interpersonal skills Ability to handle multiple duties Additional Job Details (if applicable) Additional_Job_Description Remote Type Remote Work Location 2014 Washington Street Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $ - $25.28/Hourly Grade 2 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 4100 Newton-Wellesley Hospital 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 Veteran’s 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)-282-7642. Mass General Brigham Competency Framework 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. Apply To This Job