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Form of workAt Boston Children’s Hospital, the quality of our care – and our inclusive hospital working environment – lies in the diversity of our people. With patients from local communities and 160 countries around the world, we’re committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.
- Managing the prior authorization process for patients of general providers and/or training on more complex prior authorization processes in support of multiple specialties. Preparing letters of medical necessity based on physician’s notes.
- Coordinating appeals with clinicians and patient families by preparing letters of appeal or connecting the clinician directly with the insurance company.
- Serving as a point of contact on the process for obtaining and responding to additional requests for prior authorizations for medicines across relevant insurance companies for supported clinical area.
- Answering, screening, and routing a high volume of phone and email inquiries from patients and families and external companies in coordination of clinical services.
- Recording and forwarding messages and triaging calls to nurses, physicians, and numerous other providers for urgent information or services. Initiating calls for emergency services as required.
- Responding to patient’s concerns and needs within scope of knowledge and authority and in accordance with our best practices and procedures.
- Responding to situations requiring escalated service response, ensuring the appropriate providers and parties across multiple specialty areas are made aware of concerns and following up to ensure resolution.
- Scheduling patient encounters and procedures to coordinate within and across providers in multiple specialties.
- Obtaining and recording required authorizations for prescription medication with insurance providers. Verifying patient demographics.
- Collecting all necessary clinical documentation and information.
- Collecting and organizing medical records, information, materials, and supplies required for admissions or encounters.
- Preparing requisitions and other standard forms as requested by clinician or supervisor.
- Communicating with other departments to coordinate ancillary clinical/administrative services. Preparing, routing, and tracking routine administrative forms and documents.
- Actively participating in and contributing to departmental and organizational initiatives and projects with a focus on continuous process improvement.
- Recommending and assisting in implementing changes in internal systems and procedures.
To qualify, you must have:
- High school diploma
- Some college or occupationally-specific education/training preferred
- Minimum of 1 year of experience in a high volume administrative role with an emphasis on problem resolution among multiple internal and/or external parties
- Ability to learn the prior authorization process for medicines sufficient to navigate the intricacies of the current processes and facilitate improvements
- Strong organizational skills and attention to detail
- An ability to work with diverse internal and external constituencies
- A sense of urgency and an ability to understand priorities and anticipate needs while also being flexible in order to accommodate changes in priorities
Boston Children’s Hospital requires all employees to be vaccinated against COVID-19 and Flu, (unless you are eligible for a medical or religious exemption).
Boston Children’s Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
