Financial Clearance Specialist I - Remote After Successful Training

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.
PRINCIPAL DUTIES AND RESPONSIBILITIES:

1. Order & Schedule
   1. Verifies accuracy of order and scheduled appointment details, updates information as required
   2. Confirms accuracy of patient demographics, insurance information and ordering provider details
   3. Ensures all other elements of order are appropriate by using various internal and external verification systems and department resources

1. Authorization
   1. Obtains authorization for diagnostic imaging tests via insurance portals and/or fully supports ordering practice in doing so prior to patient appointment
   2. Ensures accuracy of all information conveyed in authorization request and addresses errors in a timely fashion
   3. Gains expertise in insurance requirements and authorization workflows
   4. Develops information networks and personal relationships to maximize effectiveness
   5. Manages numerous authorization requests concurrently without impacting quality
   6. Meets management targets for authorization volume and accuracy rates

1. Result Monitoring & Tracking
   1. Employs validation techniques to maximize authorization attainment rates
   2. Supports process improvement initiatives, proactively engages supervisor
   3. Actively addresses service enhancement opportunities
   4. Ensures all "hand-offs" among colleagues are clearly communicated and mutually agreed upon

1. Other
   1. Provides cross-coverage as required
   2. Perform all other related duties appropriate to this level of position and/or as directed by the manager
   3. Observes Hospital and Department policies and procedures at all times
   4. Maintains the confidentiality and privacy of protected health information consistent with HIPAA requirements at all times

Qualifications
SKILLS & COMPETENCIES REQUIRED:

1. Time Management
   1. Proven ability to prioritize and multi-task in a busy environment
   2. Ability to identify emergent situations, formulate solutions, and take appropriate action in a timely manner and with minimum direction from supervisor

1. Attentiveness to Detail
   1. Strives for accuracy and completeness in all tasks and at all times
   2. Continually adjusts and improves processes to achieve better results
   3. Holds self directly accountable for gaining and maintaining job domain expertise

1. Communication
   1. Strives to clearly summarize and communicate critical information at all times
   2. Assesses customer interactions, both internal and external, and provides personalized communication to achieve best outcome
   3. Employs appropriate pace, tone and clarity in all customer interactions
   4. Promptly and appropriately escalates issues and service failures that cannot be resolved independently

1. Customer Orientation
   1. Recognizes opportunities to provide superior service
   2. Unyielding passion for customer care
   3. Remains calm under pressure while demonstrating a positive attitude and empathy
   4. Strives to maintain highest service standards at all times and with minimal supervision

1. Goal Oriented Focus
   1. Understands critical success factors of role and orients self to goals
   2. Cares deeply about positive customer outcomes and business results
   3. Continually strives for service excellence

1. Flexibility
   1. Ability to deal effectively and courteously with a diverse group of internal and external stakeholders
   2. Willingness to be flexible in working hours and location when needed
   3. Ability to work effectively in a team environment

1. Willingness to learn
   1. Eagerness to master job tasks
   2. Quickly learns and maintains knowledge of the following critical knowledge elements:
      1. Medical terminology
      2. CPT and Diagnosis Codes
      3. Insurance authorization policies and procedures
      4. Epic-ADT referral management processes and procedures
      5. Payment denial and claims support

LICENSES, CERTIFICATIONS, and/or REGISTRATIONS:
Not Applicable
EDUCATION:
Minimum Required:
High school diploma, GED or equivalent
Certificate : Please specify
Some college or Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
None required
Preferred:
High school diploma, GED or equivalent
Certificate : Please specify
Some college or Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
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.