Financial Access Specialist

Mass General Brigham•Boston, MA

1d•$28 - $28•Remote

About The Position

The role is responsible for financial clearance of assigned post-acute admissions across the full continuum of care within the Department, encompassing inpatient IRF, LTAC, SNF, and outpatient Therapy and Physical Medicine services across Spaulding Rehabilitation facilities. This role verifies insurance eligibility, coverage, and benefits, and manages prior authorizations from initiation through final determination. The role ensures accurate documentation in Epic and collaborates with departments such as Admissions, Case Management, Financial Counseling, and Outpatient Rehabilitation teams (administrative and clinical). The role supports timely access for patients receiving inpatient care, outpatient therapy, or outpatient procedures while maintaining financial accountability aligned with organizational goals and system-wide objectives.

Requirements

Associate's Degree Related Field of Study required
Patient access, hospital registration, or revenue cycle experience 2-3 years required
Proficiency in Epic strongly preferred, including workqueue management and authorization documentation.
Knowledge of prior authorization workflows and payer portal navigation.
Excellent attention to detail with strong organizational and time-management skills, including the ability to manage multiple priorities in a time-sensitive environment.
Ability to build effective working relationships across departments and work effectively within a team environment to support coordinated admission and authorization processes.
Demonstrated ability to handle sensitive patient information and maintain strict confidentiality in accordance with HIPAA regulations.
Ability to work independently and exercise sound judgment within established policies and procedures.
Strong communication and interpersonal skills with the ability to effectively collaborate with colleagues, leadership, insurance case managers, and payer representatives.

Nice To Haves

Can this role accept experience in lieu of a degree? Yes

Responsibilities

Responsible for financial clearance of assigned post‑acute and outpatient services, including verification of insurance eligibility, coverage, and benefits for inpatient admissions, outpatient therapy, and outpatient procedures as assigned.
Initiates and manages prior authorization requests from submission through final determination. This includes submitting required clinical documentation, conducting routine status checks through payer portals and direct communication with payers, confirming authorization details with payers when applicable, and ensuring the timely progression of each case.
Ensures all authorization activity and approval details are thoroughly documented in Epic, providing visibility across departments and supporting accurate reimbursement.
Identifies benefit limitations, network concerns, out-of-network scenarios, and other financial risks, escalating to the Manager or Financial Counselor when appropriate.
Negotiates single case agreements with Workers’ Compensation carriers and non-contracted payers as needed, including preparation of cost estimates and participation in reimbursement discussions to secure appropriate payment terms.
Responsible for monitoring and prioritizing assigned Epic Workqueues to support time‑sensitive inpatient admissions, outpatient therapy visits, and outpatient procedures as assigned, ensuring efficient referral throughput.
Communicates authorization updates, insurance requests for additional information, peer-to-peer offers, appeals, and denials to relevant stakeholders.
Prepares self-pay cost estimates when applicable and collaborates with Financial Counseling to ensure financial clearance prior to inpatient admission, outpatient therapy or outpatient procedures.