At Boston Children's Hospital, success is measured in patients treated, parents comforted and teams taught. It's in discoveries made, processes perfected, and technology advanced through major medical breakthroughs and small acts of kindness. And in colleagues who have your back and patients who have your heart. As the teaching hospital of Harvard Medical School, our reach is global and our impact is profound. Join our acclaimed Patient Financial Services and discover how your talents can change lives. Yours included.

• Overseeing pre-service patient financial clearance functions to reduce financial risk to the organization; functions include verifying insurance and benefits, acquiring payor pre-auths and/or auths, securing referrals, notifying payors of patient admission or discharge, coordinating estimates when applicable, collecting pre-service payments, coordinating financial assistance, when necessary, and navigating payers for out of network cases for specific service areas
• Ensuring collaboration between Finance and the Service Area
• Interfacing with Service Area to ensure payment agreements are secure prior to patient admission and that comprehensive estimates are provided to avoid leakage and non-payment of services not agreed upon. Monitoring payment patterns to ensure timely payment and minimization of write- offs
• Gathering clinical information and query depts/foundations on securing additional information and/or Letters of Medical Necessity to avoid unnecessary peer to peer reviews for appeals, and prepare for Medical Director review
• Ensuring all pre-auths, auths, referrals and eligibility processes are completed in a timely manner. Serving as a resource to managers and staff for the purpose of identifying and resolving payor denials attributed to financial clearance issues for both the Hospital and Professional Services
• Ensuring appropriate quality standards are maintained and appropriate on-line documentation is entered for every account activity to ensure thorough communication
• Collaborating regularly with Accounts Receivable, Contracting, Health Information Management, and Care Manager to assess opportunities for revenue improvement, as well as patient satisfaction
• Working on strategic revenue cycle efforts based on financial performance of cleared cases
• Staying current with federal, state, and financial clearance processes and requirements, as well as regulations affecting revenue cycle operations.
• Developing strategies to ensure Finance and Service Area are constantly enhancing processes to clear patients timely, including people, process, and technology changes. Interacts with Patient Relations and Customer Service Team.
• Assessing the need for and monitoring progress in obtaining single case agreements for patients from non-contracted payers

• A Bachelor's degree in Business Administration, Finance or a closely related field
• 4 years of related exp & 6 years of exp in a progressively responsible position with prior direct report responsibility or oversight within hospital. Financial clearance may be substituted for the educational requirement
• State-of-the-art awareness of billing requirements and technology related to hospital billing
• Knowledge and/or familiarity with ICD-10, CPT and HCFA coding guidelines, as well as third party billing guidelines