- Location
- 300 First Avenue Charlestown (Spaulding Rehabilitation Hospital Charlestown Navy Yard), United States of America
- Workplace
- Remote
- Type
- Full-time
- Department
- Finance
- Education
- Associate
- Source
- Workday
Description
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
SummaryThe 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.
Does this position require Patient Care? No
Essential Functions
-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.
Qualifications
Education
Associate's Degree Related Field of Study required
Can this role accept experience in lieu of a degree?
Yes
Licenses and Credentials
Experience
Patient access, hospital registration, or revenue cycle experience 2-3 years required
Knowledge, Skills and Abilities
- 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.
Additional Job Details (if applicable)
Physical Requirements
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$ - $28.30/Hourly
Grade
3
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.