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Posted: 05-Nov-25
Location: Needham, Massachusetts
Categories:
Internal Number: 149706180
The Patient Financial Navigation and Out-of-Network department plays a key role in supporting patient families, clinical, and administrative teams across the hospital by providing core business support to our under- and un-insured patients who have the appropriate access to BCH, as well as helping families navigate the complexities of insurance. Financial counseling is part of a larger team, contributing to the processes of working with insurance companies of patients who are out-of-network and working on patient access to the rare and complex care at Boston Children's.
Key Responsibilities:
- Provide critical support to the Pre-Service Financial Clearance team by developing patient estimates for authorized inpatient complex services for out-of-network payors in order to support single-case agreement contract negotiations with insurance companies
- Collaborate with clinical depts, case managers and co-workers to obtain information to insure accuracy of patient records and the optimal processing of the patients' bills
- Interview and support patient families, providing real-time assistance with public health insurance applications and financial assistance policies and programs.
- Receive and resolve patient inquiries about insurance coverage and financial assistance questions through face to-face meetings, telephone calls and correspondence to ensure patient families have eligibility information and assistance with navigating applications to access state and federal public health insurance products, or commercial insurance companies in a professional manner.
- Create, validate, and complete patients' registration, estimate for services, and/or encounter bill for services as needed. Collect any outstanding balances and updates all demographic and insurance information during patient contacts. Obtain and record payments from patients/ families.
- Alert management of any patient family financial navigation issues in a timely manner to reduce financial risk to the organization. Maintain family contacts and when possible, assists in developing solutions to problems.
- Collect and assign referrals received by phone, fax, and or electronically
- Troubleshoot issues related to insurance coverage issues. Collaborate with patients, insurance companies, and hospital staff to resolve issues in an accurate and timely fashion.
Minimum Qualifications
Education:
- The completion of High School Diploma or associate's degree is a minimum requirement with at least 6 months of experience, preferably in a healthcare setting. College level education is preferred
- Experience in a Hospital or Third Party insurance billing is preferred.
- Analytical skills to resolve problems that require the use of basic scientific, mathematical, or technical principles.
- Ability to communicate effectively both orally and in writing; Bilingual skills are a plus.
- Ability to collaborate with others in an effective manner, and handle sensitive information and or issues in a confidential and respectful manner
- Certified Assistance Counselor with MassHealth preferred; willingness to train and be credentialed required.
The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.
Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.
