Senior Financial Clearance Specialist

Position Overview

When you join the growing BILH team, you're not just taking a job – you’re making a difference in people’s lives. This full-time, Day shift position with a Hybrid work schedule supports Beth Israel Lahey Health’s (BILH) mission by ensuring that all information necessary for proper financial reimbursement for high-dollar patient care is accurately analyzed and submitted to insurance companies prior to a patient’s date of service. You will collaborate with insurance companies to validate benefits, eligibility, and referral requirements, and communicate with patients to help them understand their payment obligations while maintaining a positive experience.

Key Responsibilities

• Access and review work queues and patient accounts to determine financial clearance status and take action on services without clearance.
• Verify and update patient demographic and contact information with the patient or their representative.
• Ensure guarantor information is correct for various coverage types including workers’ compensation, third-party insurers, and others as needed.
• Create and verify all possible coverages — either electronically or manually — and resolve discrepancies by validating proper assignment to visits.
• Collect and validate visit-related registration details including MSPQ, occurrence codes, and details of attending and referring providers.
• Verify Primary Care Physician (PCP) details and ensure appropriate referrals are in place; process and link referrals accordingly.
• Manage referrals by ensuring proper tracking and redirection in line with clinical protocols.
• Identify non-covered services through system activities and prepare necessary Advance Notice Beneficiary (ABN) or waiver documentation.
• Analyze clinical documentation, submit precertification requests, follow up on pending accounts, and involve provider offices as needed.
• Escalate challenging or urgent accounts to provider representatives or clinical leadership to secure timely approvals.
• Collaborate with clinical departments to schedule procedures and communicate outcomes to patients professionally.
• Verify covered benefits, including remaining hospital days, carve-out coverages, and benefit limits.
• Communicate with patients, providers, and insurance companies to validate and collect missing information as well as resolve discrepancies.
• Understand clinical guidelines for authorizations, build cases for requests, and provide feedback to respective departments.
• Guide patients regarding financial clearance issues, including advising on self-payment options and directing them to Lahey Financial Counselors when appropriate.
• Research claim edits and payment denials in partnership with Lahey Patient Financial Services to resolve issues and communicate resolutions to patients.

Required Qualifications

• High School Diploma or equivalent.
• At least two years of experience in a business or health care setting.
• Knowledge of insurance coverage and/or reimbursement processes.
• Experience in providing customer service while processing and verifying electronic demographic and financial data.
• Ability to work successfully in a fast-paced, multi-task environment that sometimes requires independent decision-making.
• Strong written and verbal communication skills in English for effective interaction with patients, visitors, and colleagues.
• Mandatory: Must be vaccinated against influenza (flu) as a condition of employment.