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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 and financial clearance in a healthcare setting, with strong skills in insurance verification and customer service. Proficient in using Epic and other ancillary systems to manage high-volume requests while maintaining accuracy and confidentiality.
Highest-signal resume keywords
Prior Authorization ProcessingInsurance VerificationEpic ExperienceHigh-Volume Data EntryCustomer Service Skills
About the role
Key responsibilities & impact- Screen and prioritize prior-authorization and specialized-services requests for inpatient, outpatient, and ancillary services
- Process requests and authorize specified services under departmental guidelines and manager supervision
- Refer requests requiring clinical judgment to the Prior Authorization Clinician, Manager, or Medical Director
- Answer ACD calls, verify member eligibility, enter information into CCMS or Facets, and redirect calls as needed
- Identify network providers, services, and member benefits; communicate authorization decisions to providers
- Coordinate resolution of escalated member and provider inquiries
- Monitor registration and prior-authorization work queues and obtain required patient and payer financial-clearance elements
- Obtain and document referrals and prior authorizations in Epic before scheduled services
- Coordinate with practices, physicians, insurers, patients, case management, and Patient Financial Counseling
- Serve as liaison between physicians and payers for peer-to-peer reviews
- Escalate denied or financially uncleared accounts according to policy
- Interview patients, families, and referring physicians to collect financial, demographic, insurance, and reimbursement information
- Validate and reconcile registration and insurance information, eligibility, primary care physician, subscriber, employer, and appointment data
- Refer self-pay or unresolved-insurance patients to Patient Financial Counseling
- Maintain confidentiality and comply with healthcare collection laws and regulatory policies
- Meet productivity, quality, accuracy, and turnaround-time standards; undergo quality audits
- Participate in training, educational offerings, orientation of new personnel, and process-improvement initiatives
- Report faulty systems or hardware to the Help Desk and coordinate equipment servicing
- Perform other related duties as assigned
Requirements
What you’ll need- High school diploma or GED required
- Associate’s Degree or higher preferred
- 4-5 years of office experience, specifically 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-volume requests with a 95% or greater accuracy rate
- Ability to prioritize workload within specified turnaround timeframes
- Thorough knowledge of the financial clearance process
- Familiarity with 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
- Basic computer proficiency, including Microsoft Excel, Word, Outlook, and Zoom
- Ability to maintain strict confidentiality of personal and health-sensitive information
- Strong oral and written communication, collaboration, organization, multitasking, judgment, customer service, and decision-making skills
- Bilingual preferred
- Certificates, licenses, and registrations: None required
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 position
- Per diem, part-time schedule
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 EntryMedical TerminologyReferral AuthorizationThird-Party BillingAccuracy Rate
Soft Skills
Communication SkillsCollaborationOrganizationMultitaskingDecision-Making
Tools & Technologies
EpicMicrosoft ExcelMicrosoft WordMicrosoft OutlookZoomCCMSFacets
Industry Keywords
HealthcarePatient Financial CounselingInsurance Payer WebsitesHigh-Volume Office ExperienceConfidentialityRegulatory Policies