Financial Review Specialist

Northern Light Eastern Maine Medical Center

Department: Infusion Services

Position is located: Lafayette Building

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: Variable

Summary :

The Financial Review Specialist is responsible for coordinating the day-to-day operations of insurance verification, PCP referrals, medical necessity screening and prior authorizations for specialized outpatient infused drugs, procedures and imaging. Responsible for understanding the complexities of commercial and government-funded health plan requirements. These include variations in coverage guidelines and payer documentation required to request and appeal submissions.

Responsibilities :

• Assists pharmacists and patient advocates with urgent and/or complex pre-certification needs.
• Acts as a liaison between staff, Financial Counselor, Scheduling and Check-In to ensure coverage of all services.
• Responsible for educating staff on new and existing insurance verification software. This includes securing access, instructing on documentation standards and QA post-implementation.
• Conducts periodic quality audits of routine transactions in a quantitative format.
• Orients new insurance verification employees using a skills assessment tool and advises manager of progress.
• Assists Manager and the Revenue Cycle Team with process improvement.
• Covers insurance verification, PCP referral, medical necessity screening and prior authorization functions as needed.

Other Information :

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

• Required Associate's Degree

Working Conditions

• Potential exposure to noise levels being uncomfortable.
• Work with computers, typing, reading or writing.
• Prolonged periods of sitting.
• Prolonged periods of standing. Prolonged periods of walking.
  

Northern Light Eastern Maine Medical Center is a 411- bed, regional tertiary care hospital and an American College of Surgeons-verified Level II Trauma Center. Located in Bangor, Maine, it serves as the principal referral center for a patient population of 500,000 residents across the northern two-thirds of the state. The medical center provides comprehensive inpatient and outpatient services, including advanced surgical care, neurosciences, cardiovascular medicine, oncology, and critical care.

Eastern Maine Medical Center is the base for LifeFlight of Maine, a critical care air medical transport program that conducts nearly 900 missions annually, ensuring timely access to specialized care for rural and remote communities. As a member of Northern Light Health, the medical center is part of an integrated statewide health system comprising nine hospitals, numerous primary and specialty care practices, long-term care facilities, home health and hospice agencies, and emergency ground and air transport services. This integrated model supports coordinated, patient-centered care across the continuum.

Eastern Maine Medical Center plays a central role in advancing clinical quality, operational efficiency, and health equity throughout the region. It is actively engaged in clinical education and serves as a training site for medical students, residents, and fellows through affiliations with academic and professional institutions.

Bangor, Maine offers a stable and supportive environment for healthcare professionals. The region is home to high-performing public and private schools, including the University of Maine’s flagship campus in Orono. Bangor International Airport provides convenient commercial air service with direct and connecting flights to major US hubs. The area also offers access to a wide range of cultural, educational, and recreational opportunities, with outdoor activities available year-round in Maine’s forests, lakes, mountains, and coastal regions.

Northern Light Eastern Maine Medical Center is a strategic hub for clinical excellence, innovation, and community health in northern New England.

Questions? Contact Talent Acquisition:
phone: 207-973-7100
email: talentacquisition@northernlight.org

EMMC, Bangor, Maine, Level 2 Trauma Center, hospital, Cancer Care, Lifeflight