BILLING MANAGED CARE COORDINATOR/ PER DIEM/ DAY - OBGYN
Brigham & Women's Hospital(BWH)

Boston, Massachusetts


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

GENERAL SUMMARY AND OVERVIEW STATEMENT: Supervised by the Managed Care Supervisor, the Managed Care Coordinator is responsible for obtaining appropriate insurance authorizations, referrals and payments for all patient visits and procedures as well as collection of patient service coinsurance, deductibles and self pay revenue for the Department of OB/GYN Center for Infertility and Reproductive Surgery. There is a high level of direct or phone patient/physician interface.

PRINCIPAL DUTIES AND RESPONSIBILITIES

  • Responsible for obtaining insurance approval for all related activities for Brigham Center for Infertility and Reproductive Surgery and Satellite operations, prior to initiation of patient services. Duties include but are not limited to verifying insurance eligibility and benefits, reviewing clinical notes and lab tests to gather information for insurance approval, completion of insurance authorization forms, submitting authorizations to insurance and ensuring receipt and timely response.
  • The MCC is also responsible to ensure appropriate referrals are on file for the treatment cycle as well as collecting non-covered service revenue, identifying and collecting payments for non-covered patient service revenue which includes but is not limited to past due balances, non-covered services; deductibles and coinsurance. Also, responsible for correct and accurate posting of prepayments in the EPIC billing system.
  • Explaining insurance coverage to patients, advising patients regarding outstanding lab work and procedures that are required prior to authorization submission. The MCC documents in EPIC as notification to the clinical staff patients who have not completed the required testing for insurance approval. The MCC also is required to verify cycle starts, review charts, scan records and communicate on all matters BWPO Billing Office


  • Responsible for ensuring insurance authorizations and referrals are received for all IVF cycle services which may include working with the patient's primary care physician or patient to obtain a referral, providing education to practice staff to regarding which services are and are not covered by each insurance plan and which require a referral. Interface with BWPO EPIC Billing system is required, as necessary.


  • The Managed Care Coordinator is responsible for the daily creation of patient episodes once authorization is obtained, launching patient scribes in ARTSITE, as well as start list verifications, daily approval list emails to the BWH CIRS team, scanning authorization requests in the RMS electronic filing system as well as overall financial clearance of the patient.
  • The MCC requires comprehensive knowledge of insurance eligibility and benefits as well as be able to navigate through payer policy and act as a champion for patient approval.


  • The MCC is also responsible to ensure patients have signed self pay waivers and contracts when appropriate, understand the refund process and the BWH/PO billing model. Also, responsible for ensuring signed documents are scanned into the electronic filing system (RMS). Responsible for explaining fee structures to patients for various treatment options and all other special programs.


  • Responsible for handling all patients' billing inquiries made through the practice and resolve or triage the inquiry to the appropriate BWH Account specialist. Also, responsible for working with OBGYN billing and analytical staff to ensure appropriate authorization is on file prior to billing patient's treatments and/or updating authorizations, contacting patients if benefits/plan has changed post treatment.


  • Receives and expedites all incoming/outgoing telephone calls in a professional and courteous manner. High level of communication required between clinical team, patient and BWPO management. Must be able to work as a team and collaborate and contribute to solving problems.


  • May also be responsible for determining and entering charges into the BWPO physician, communicating appropriate information to BWPO, updating registrations and notifying billing team if patient's report a change or change is discovered, as well as performing cross-coverage duties, as necessary, for other Coordinators as well as the Managed Care Supervisor.


  • The employee work area is expected to be neat and clean at all times.


  • The employee is expected to adhere to the rules and regulations of the BWPO and BWH


  • The employee must demonstrate initiative, independence and a willingness to learn new tasks.


  • PRINCIPAL DUTIES AND RESPONSIBILITIES: Indicate key areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation.

    For all positions that include direct patient care, indicate with an "X" the age(s) of all patient populations served

    No Direct Patient Care

    X

    All age groups

    Adolescence (13 to 17 years)

    Neonates (birth to 1 month)

    Young Adult (18 to 25 years)

    Infant (1 month to1year)

    Adult (26 to 54 years)

    Early Childhood (12 months to 5 years)

    Senior Adult (55 to 64 years)

    Late Childhood (6 to 12 years)

    Geriatric (65 years and up)

    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.)

    Intermediate knowledge of third-party payers

    Excellent interpersonal skills, written and oral communication skills

    Accuracy, with attention to detail

    Ability to work both independently and as part of a team

    Computer skills, including word processing, data entry, and knowledge of EPIC billing system a plus

    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, revnue, etc.

    Responsible for self pay collections

    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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