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Boston Medical Center (BMC)Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing prior authorizations, insurance verification, and financial clearance within healthcare settings, while maintaining compliance with regulatory policies and confidentiality standards. Proficient in utilizing Epic and Microsoft Suite to manage high-volume requests and ensure accurate documentation.
Highest-signal resume keywords
Prior Authorization ProcessingInsurance VerificationEpic ExperienceFinancial Clearance KnowledgeHigh-Volume Data Entry
About the role
Key responsibilities & impact- Screen and process prior-authorization and specialized-services requests for inpatient, outpatient, and ancillary services
- Coordinate pre-registration, patient demographics, insurance verification, referrals, authorizations, and precertifications
- Prioritize requests and refer those requiring clinical judgment to the appropriate clinician, manager, or medical director
- Answer provider and department ACD calls, verify member eligibility, and enter information into CCMS or Facets
- Identify network providers, services, and member benefits; communicate authorization decisions
- Monitor registration and prior-authorization work queues and obtain required financial-clearance information
- Navigate BMC and payer policies to obtain authorizations, precertifications, and referrals
- Document referral and prior-authorizations in Epic and link approval numbers to patient appointments
- Collaborate with practices, physicians, insurers, patients, case management, and Patient Financial Counseling
- Liaise between physicians and payers for peer-to-peer reviews
- Escalate denied or financially uncleared accounts according to policy
- Interview patients, families, or referring physicians to collect financial, demographic, and insurance information
- Reconcile and update demographic, insurance, eligibility, primary-care, subscriber, employer, and appointment information
- Maintain confidentiality and comply with healthcare collection laws and regulatory policies
- Meet productivity, quality, accuracy, and turnaround-time standards
- Participate in training, quality audits, onboarding, and process-improvement initiatives
- Report faulty systems or hardware to the appropriate support department and perform other assigned duties
Requirements
What you’ll need- High school diploma or GED required
- 4–5 years of office experience in a high-volume data entry office, customer service call center, healthcare office, or hospital administration
- Experience using insurance payer websites, such as Blue Cross Blue Shield and Medicare
- Experience with insurance verification, prior authorization, pre-certification, and financial clearance processes
- Ability to process high volumes of requests with 95% or greater accuracy
- Ability to prioritize workload within specified turnaround timeframes
- Thorough knowledge of the financial clearance process, insurance, referral authorizations, and third-party billing procedures
- Basic medical terminology and ICD-9/CPT coding knowledge helpful
- Epic experience preferred; technical proficiency in Epic work queues and ancillary systems including ADT/Prelude/Grand Centrale
- Microsoft Suite proficiency, specifically Excel, Word, Outlook, and Zoom
- Ability to maintain strict confidentiality of personal and health-sensitive information
- Ability to multitask, manage complex processes, and make independent decisions under pressure
- Bilingual preferred
- Associate’s degree or higher preferred
Benefits
Comp & perks- Medical, dental, vision, and pharmacy benefits
- 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
- Educational offerings and development opportunities
- Remote work
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Prior AuthorizationInsurance VerificationFinancial ClearanceICD-9 CodingCPT CodingData EntryReferral AuthorizationThird-Party BillingMedical TerminologyConfidentiality Compliance
Soft Skills
MultitaskingIndependent Decision-MakingCustomer ServiceCommunicationTime Management
Tools & Technologies
EpicMicrosoft ExcelMicrosoft WordMicrosoft OutlookMicrosoft ZoomCCMSFacetsADTPreludeGrand Centrale
Industry Keywords
Healthcare AdministrationPatient Financial CounselingInsurance Payer WebsitesHigh-Volume Office ExperienceBilingual