Patient Financial Navigator
Department Description: Supports revenue cycle department.
Job Location: Boston, Massachusetts
Req ID: 46278BR
Job Summary: This position will provide focused and dedicated support to manage existing and future requirements of the No Surprises Act for transactions financially cleared by the Revenue Cycle Team. This position will also serve as additional support for all financial clearance activities within the Revenue Cycle.
- Verifies patient's insurance eligibility and out of network or non-participating services using various online tools and by contacting the payer directly.
- Generate and provide patients with ¿good faith¿ estimates for medical services considered out of network or non-participating by that patient's insurance plan.
- Estimates will be provided based on information known at the time and will be provided to patients in advance of services in accordance with the No Surprises Act timelines.
- Communicates to patients to ensure receipt of estimates and responsible of informing patients that signed forms are required prior to services being rendered to acknowledge financial responsibility.
- Responsible for providing, tracking, receiving and maintaining all estimates and associated documentation. Coordinates with the billing team to ensure compliance of No Surprises Act.
- Identifies payer medical necessity determination before services are rendered. Informs departments of failed instances. When circumstances dictate, requests additional information to re-run medical necessity check.
- Determines authorization requirement and, when necessary, obtains authorization from payer by utilizing payer specific protocols. Requests and coordinates any additional information from departments when needed.
- Identifies and escalates issues timely and appropriately for resolution and communicates and coordinates with revenue cycle peers, leadership and clinical stakeholders. Documents interim and final results in appropriate systems.
- Completes assigned work queues and reports daily to achieve standards of productivity and quality. Assists with reviewing medical necessity and obtaining authorization for urgent or walk-in visits. Refers patients to financial counselors to resolve complex financial issues and/or inquiries.
- Follows BIDMC policies, procedures and training materials to ensure compliance to federal, state, and contractual requirements. Identifies trends and provides periodic reports to departments on operational, productivity, and quality metrics. Performs other activities on an as-needed basis to support the department.
- High School diploma or GED required. Associate's degree preferred.
- 1-3 years related work experience required.
- Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) coding and International Classification of Diseases (ICD-9, ICD-10).
- Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
- 3+ years of related experience; two or more years of prior work experience in Financial Clearance activities.
- Knowledge of payer policies for medical necessity/authorization requirements.
- 3. Prior experience working with Craneware software.
- Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
- Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
- Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
- Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
- Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
- Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
- Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
- Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
BIDMC is EOE M/F/VET/DISABILITY/GENDER IDENTITY/SEXUAL ORIENTATIONVaccines
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. BILH requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment.