Billing Coordinator
Brigham & Women's Hospital(BWH)

Boston, Massachusetts


BRIGHAM AND WOMEN'S HOSPITAL

Job Title: Billing Coordinator Date: 01/21/21

Job Code: 00894D Grade: 210Z FLSA Status: Non-Exempt

Department: Orthopaedic Surgery Reviewed By: Laura Byrne/Michelle Kennedy

Reports To: Orthopedics Operations Supervisor(s) Date revised: 01/08/21

01/21/21

GENERAL SUMMARY/ OVERVIEW STATEMENT: Summarize the nature and level of work performed.

GENERAL SUMMARY AND OVERVIEW STATEMENT: Under the direction of the Director of Orthopaedics and supervised by the Operation Supervisors at the Main Campus, the Billing Coordinator (BC) is responsible for ensuring front end Billing Operations are within the standards of Brigham Health and for all clinic locations of the Dept of Orthopedic Surgery. It is a multi-faceted position and encompasses an understanding of frontend operations, clinic billing functions, and insurance coverage options (plan types, contracted vs. non-contracted plans, Self-Pay, Third Party Payers, Free-Care, etc.). The BC is responsible for obtaining appropriate insurance authorizations and referrals for all patient visits and procedures for patients with no insurance or patients with BWPO non-contracted plans. Additionally, s/he conducts in-services and initial trainings for front end billing procedures for staff, supports Administrative Assistants and Schedulers with insurance coverage questions. There is a high level of direct or phone patient and department staff interface.

PRINCIPAL DUTIES AND RESPONSIBILITIES

  • Responsible for clearing patients for insurance approval for all related activities for the Dept of Orthopedics for the Brigham and Satellite ambulatory clinic operations, prior to the scheduling of patient visits for patients with insurance issues as defined by policy. Duties include verifying insurance eligibility and benefits and ensuring and/or reviewing referral reports to verify active referrals on file for each patient visit.


  • Responsible for running daily ambulatory and Opt Time schedule reports and reviewing them for patient coverage issues. Also, responsible for reviewing work ques in the billing system (Epic) in order to resolve patient coverage issues. This includes but is not limited to following up with individual patients and physicians' offices to resolve said coverage issues before patients can be scheduled or rescheduled. This includes contacting patients and rescheduling/cancelling.


  • Explaining insurance status to patients and Department staff on those patients who do not have approval to be seen. Act as liaison to CPBO on these issues. Act as point person for all staff regarding Ambulatory authorizations and referrals. Requires detailed knowledge of insurance requirements and close attention to patient scheduled appointments since each insurance company has different prior authorization and referral plan requirements.


  • Oversees the triaging of Self Pay/International/Non-Pay patients to appropriate providers. Ensures compliance with the Partners and Department Collection Policy.
  • Serves as a direct patient/staff resource for all matters related to Free Care/HSN patient population. Must be up to date on all State/Federal Programs available with the goal of maximizing revenue where possible.
  • Provide training programs to Department administrative and ambulatory clinic staff on coverage issues in the ambulatory setting. Educate them on what to do for patients without insurance, with insurance we do not accept, or with insurance that requires Prior Authorization.


  • Responsible for ensuring insurance referrals are received for all outpatient procedures as required by the Payors.


  • Proficient use of the BWPO EPIC Billing system is required.


  • Receives and expedites all incoming/outgoing telephone calls in a professional and courteous manner. High level of communication required between clinical teams, patient and BWPO management.


  • ADDENDUM

  • Runs 2 day scheduling report daily.
  • Reviews Missing Referral Work Queue daily.
  • Reviews Opt Time Work Queue daily.
  • Reviews Non-Contracted Plans Work Queue daily.
  • On a daily basis, communicates and works with the Administrative Assistants, Schedulers, Clinic staff and patients to resolved issues related to referrals, Prior Authorizations and insurance coverage associated with appointment scheduling and Opt Time work queues.
  • Aides and runs surgical in the procurement of urgent Prior Authorizations. Also is available to assist in obtaining prior authorizations.


  • QUALIFICATIONS: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

    Customer service experience required

    Two-year college degree preferred

    1-3 years' experience in health care setting and extensive knowledge of 3rd party payers and billing requirements, preferred

    SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

    Requires detailed knowledge of insurance requirements including Medicare, HMO, and fee for service billing. In depth understanding of referral and authorization process for 3rd party payers.

    Excellent analytical, organizational and problem-solving skills

    Excellent interpersonal skills

    Excellent written and oral communication skills

    Accuracy, with attention to detail

    Ability to work both independently and as part of a team

    Computer skills, including Epic or similar medical management or medical billing software

    Ability to work under pressure, multi-task and meet deadlines

    Familiarity with common office equipment

    WORKING CONDITIONS: Describe the conditions in which the work is performed.

    Pleasant, but active, office environment.

    SUPERVISORY RESPONSIBILITY: List the number of FTEs supervised.

    None

    FISCAL RESPONSIBILITY: Indicate financial "scope" information, i.e.: size of budget, volume, revenue, etc.

    APPROVAL:

    (NAME)

    Department Mgr. ____________________ Title: ___________________ Date: ____________

    (NAME)

    Other, As Appropriate ___________________ Title: ___________________ Date: ___________

    The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of personnel so classified.

    Job Title: __ BWPO Referral Coordinator _____________________ Department ID: BR _ _ _ _

    PHYSICAL/ENVIRONMENTAL REQUIREMENTS OF JOB

    Indicate requirements and frequency by placing an "X" in the appropriate box.

    Work Environment:
    Activity

    Amount of Time Spent

    None

    1 - 25%

    25 - 50%

    50 - 75%

    Over 75%

    Outdoor weather conditions

    X

    Extreme cold (non weather)

    X

    Work in high place(s)

    X

    Work in confined space(s)

    X

    Risk of electrical shock

    X

    Risk of radiation exposure

    X

    Exposure to blood borne pathogens

    X

    Flammable/explosive gases

    X

    Toxic / caustic chemicals

    X

    Dust or other irritants

    X

    Grease or oils

    X

    Hazardous specimens

    X

    Exposure to lab animals

    X

    Infectious / contagious disease

    X

    Cleaning agents/chemicals

    X

    Hot equipment

    X

    Noisy equipment

    X

    Humid or wet conditions (non -weather)

    X

    Other

    Lifting/Carry Requirements of this job
    No Lifting required

    X

    No Carrying required

    X

    Number of pounds
    Amount of Time

    1 - 25%

    25 - 50%

    50 - 75%

    Over 75%

    Lift
    Carry
    Lift
    Carry
    Lift
    Carry
    Lift
    Carry

    Up to 10 pounds

    Up to 25 pounds

    Up to 50 pounds

    Up to 100 pounds

    Over 100 pounds

    Push/Pull Requirements of this job:
    No Pushing required

    X

    No Pulling required

    X

    Number of pounds
    Amount of Time

    1 - 25%

    25 - 50%

    50 - 75%

    Over 75%

    Push
    Pull
    Push
    Pull
    Push
    Pull
    Push
    Pull

    Up to 10 pounds

    Up to 25 pounds

    Up to 50 pounds

    Up to 100 pounds

    Over 100 pounds

    Physical Activity requirements of this job:
    Activity
    Amount of Time Spent

    None

    1 - 25%

    25 - 50%

    50 - 75%

    Over 75%

    Stand

    X

    Walk

    X

    Sit

    Use of hands requiring fine motor skills and sense of touch

    X

    Move / rotate / bend wrist(s)

    X

    Type / use keyboard or other data entry device

    X

    Reach with hands & arms

    X

    Climb stairs

    X

    Climb ladder or other equipment

    X

    Drive / operate motor vehicle

    X

    Balance

    X

    Stoop, kneel, crouch, bend, crawl

    X

    Speak

    X

    Hear

    X

    Taste

    X

    Smell

    X

    Other

    Vision Requirements of this job:
    Vision Requirement

    Required

    Not Required

    Close vision

    X

    Distance vision

    X

    Color vision

    X

    Peripheral vision

    X

    Depth perception

    X

    Ability to adjust focus

    X

    Other

    X

    Safety equipment used while performing this job:

    Safety eye glasses

    Gowns

    Filter lens (welding/soldering)

    Scrubs

    Face shields

    Boots

    Ear plugs or Mufflers

    Hard hat

    Surgical mask / dust mask

    Coveralls

    Self contained breathing apparatus (SCBA)

    Gloves

    Other

    Level of noise typical in this work environment:

    Very quiet

    Quiet

    Moderate

    X

    Loud

    Very loud

    Qualifications
    QUALIFICATIONS: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

    Customer service experience required

    Two-year college degree preferred

    1-3 years' experience in health care setting and extensive knowledge of 3rd party payers and billing requirements, preferred

    SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

    Requires detailed knowledge of insurance requirements including Medicare, HMO, and fee for service billing. In depth understanding of referral and authorization process for 3rd party payers.

    Excellent analytical, organizational and problem-solving skills

    Excellent interpersonal skills

    Excellent written and oral communication skills

    Accuracy, with attention to detail

    Ability to work both independently and as part of a team

    Computer skills, including Epic or similar medical management or medical billing software

    Ability to work under pressure, multi-task and meet deadlines

    Familiarity with common office equipment

    EEO Statement
    Brigham and Women's Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.



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