Position Summary
The Senior Financial Access & Revenue Cycle Specialist is responsible for managing complex patient accounts, including gene therapy and other specialized treatments, by coordinating financial intake, payer policy review, pre-service financial clearance, and other revenue cycle activities. This role ensures patient access to care while supporting accurate payer reimbursement.

Reporting to the Revenue Cycle Operations Manager within Patient Financial Services (PFS), this position collaborates closely with providers, clinical teams, billing and accounts receivable staff, and external payers to support successful financial clearance and revenue cycle performance. The role requires strong organization, accountability, and attention to detail to ensure financial readiness for advanced treatment programs at Boston Children’s Hospital.

Successful candidates must be willing to develop expertise across all aspects of revenue cycle operations, including multiple payer types and patient geographies, while maintaining a strong commitment to patient families and financial outcomes.

Key Responsibilities

• Serve as a key member of the Patient Financial Navigation team, ensuring compliant and timely financial readiness for patients approved for gene therapies and other highly specialized treatments.

• Review payer policies and requirements to determine authorization criteria, documentation requirements, and review processes for complex care and newly approved treatments.

• Submit and monitor prior authorizations while coordinating closely with Clinical Operations, Patient Financial Services leadership, Pharmacy, and provider teams to ensure accuracy and readiness for care delivery.

• Participate in internal meetings to provide updates on patient cases, share payer insights, and maintain accurate documentation across systems.

• Maintain detailed pre-service financial readiness activities, including collaboration with financial counselors to review cost estimates, ensure patients maintain active coverage, and explore secondary coverage when applicable. Escalate coverage gaps or payer issues when necessary.

• Coordinate Single Case Agreements when required, including negotiation and completion to support financial clearance and expected reimbursement.

• Ensure timely and accurate documentation of all financial activities within EPIC and other internal systems to support patient experience, clean claims, and timely payment.

• Support billing and accounts receivable teams to ensure claims are submitted correctly, processed by payers, and reimbursed according to agreed terms. Escalate payer issues when necessary.

• Track patient accounts from financial clearance through discharge and support post-service claim resolution to ensure a strong revenue cycle process.

• Maintain documentation, payer contacts, reference materials, and operational resources to support team knowledge and process consistency.

• Handle sensitive patient and payer information with a high degree of accuracy, professionalism, and compliance with hospital policies and regulatory standards.

• Contribute to continuous improvement initiatives within Patient Financial Services to enhance patient experience, operational efficiency, and scalability of financial navigation processes.

• Collaborate across departments including Payor Relations, Contracting, and Financial Counseling to support patient satisfaction and revenue cycle performance.

• Represent the department in internal meetings and provide updates on financial readiness for prospective patients.

• Support departmental goals, initiatives, and operational work plans to strengthen revenue cycle outcomes.

Education
Bachelor’s degree required; Master’s degree preferred.

Experience
Minimum of 5 years of experience in healthcare revenue cycle, patient financial services, or a related field.