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Role Description

The Pre-Service Center (PSC) Verification Specialist role belongs to the Revenue Cycle Patient Access team and is responsible for coordinating all financial clearance activities by navigating all pre-registration, obtaining referral authorization, or precertification number(s), and pre-service cash collections. This role ensures timely access to care while maximizing BMC hospital reimbursement.

• Monitors accounts routed to registration, referral, and prior authorization work queues.
• Maintains knowledge of and complies with insurance companies’ requirements for obtaining prior authorizations/referrals.
• Acts as subject matter experts in navigating both the BMC and payer policies.
• Supports BMC staff at all levels for hands-on help in understanding financial clearance issues.
• Uses appropriate strategies to obtain insurance verification, authorizations, and referrals.
• Obtains and documents all referral/prior authorizations for scheduled services prior to admission within the Epic environment.
• Works collaboratively with various stakeholders to ensure required managed care referrals and prior authorizations are obtained.
• Utilizes computer-based tools or contacts appropriate parties to obtain/generate referral/authorization information.
• Performs follow-up activities indicated by relevant management reports and work queues.
• Communicates with patients, providers, and other departments to resolve issues with obtaining required referral/prior authorizations.
• Escalates accounts that have been denied or will not be financially cleared.
• Interviews patients, families, or referring physicians to obtain necessary information.
• Accepts registration updates from various intake points.
• Ensures updated demographic and insurance information is accurately recorded.
• Reviews registration and insurance information in systems and reconciles with information from insurance carriers.
• Creates new registration records for patients new to Boston Medical Center.
• Processes current copayments, coinsurance, and/or deductibles for scheduled visits.
• Maintains confidentiality of patients’ financial and medical records.
• Participates in educational offerings and complies with organizational workflows.
• Demonstrates knowledge & skills necessary to provide a level of customer experience aligned with BMC management expectations.
• Establishes relationships and collaborates with revenue cycle staff for continuous improvement.
• Handles telephone calls in a timely fashion, following applicable scripting and customer service standards.
• Regularly undergoes Managed Care Quality Audits.
• Organizes and maintains work area for efficiency, neatness, and safety.
• Maintains patient confidentiality, including compliance with HIPAA.
• Follows established hospital infection control and safety procedures.
• Attends all necessary hospital and department training as required.
• Performs other related duties as assigned or required.

Qualifications

• High School or equivalent required.
• Additional professional certifications or completion of Revenue Partners training programs are preferred.
• SDK class training is strongly preferred.

Requirements

• At least one year of registration experience.
• Advanced knowledge of insurance payers and requirements.
• Strong customer service skills with sound judgment, independent thinking, creativity, and problem-solving ability.
• Solid understanding of healthcare insurance (HMO, PPO, authorizations).
• Excellent verbal and written English communication skills.
• Exceptional interpersonal skills, professionalism, empathy, and the ability to build effective relationships.
• Comfortable working independently, handling ambiguity, and balancing multiple competing priorities.
• Close attention to detail with strong decision-making and judgment capabilities.
• Experience with Epic preferred, including proficiency in Epic workqueues.
• Strong understanding of Revenue Cycle processes.
• Advanced computer proficiency, including Microsoft Office (Excel, Word, Outlook, Teams).
• Team-oriented, able to work cross-functionally.
• Proven ability to handle challenging situations while maintaining strict confidentiality.

Benefits

• Compensation Range: $24.05- $29.31.
• Generous total compensation including benefits (medical, dental, vision, pharmacy).
• Contract increases, Flexible Spending Accounts, 403(b) savings matches.
• Earned time cash out, paid time off, career advancement opportunities.
• Resources to support employee and family wellbeing.