At Boston Children's Hospital, the quality of our care - and our inclusive hospital working environment - lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.
This Clinical Access Manager will be responsible for: - Expediting patient processing and reduces financial risk to the organization by providing clinical support to all PFS staff as part of the insurance clinical authorization process.
- Conducting first-level peer to peer discussions with payors, as needed, to facilitate the approval of medically necessary care for our patients.
- Acting as an advocate for the patients and the physicians with the health plan & other interested parties in order to gain clinical approval for the requested care.
- Staying abreast of payor rules and requirements for financial clearance issues, especially related to clinical requirements & guidelines. Helping provide education and consultation to physicians, nurses and administrative staff on these rules and requirements.
- Collaborating regularly with accounts receivable, case management, physicians' offices, contracting, Health Information Management, and other clinical areas to assess opportunities for revenue improvement, as well as patient satisfaction through existing hospital designated .
- Interfacing with all Revenue Cycle Departments to ensure clinical authorizations 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 the minimization of write- offs.
- Staying current with federal, state, and financial clearance processes and requirements, as well as regulations affecting revenue cycle operations. Using this knowledge to develop and/or modify policies and procedures as necessary.
To qualify you must have: - A Bachelor's degree in business, health care administration, or a closely related field. Nursing degree preferred.
- 3 years broad-based clinical experience in an inpatient medical surgical or equivalent pediatric setting. Pediatric cardiology and complex care experience preferred.
- Experience working with insurance companies, such as in a case/care management setting. Basic knowledge navigating ICD10 and CPT nomenclature.
- Equivalent combination of education and experience which provides proficiency in the areas of responsibility may be substituted for the stated education and experience requirements.
Please note: During a public health emergency, individuals in this role may be expected to take on additional duties to respond to organizational needs.
Boston Children's Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, cell phone plan discounts and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability. |
