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Financial Billing Managed Care Coordinator/ 40 HOURS / DAY / OBGYN

Company: CTI Education Group
Location: Brookline
Posted on: May 3, 2021

Job Description:

Job Description - Financial Billing Managed Care Coordinator/ 40 HOURS / DAY / OBGYN (3150015) Financial Billing Managed Care Coordinator/ 40 HOURS / DAY / OBGYN - ( 3150015 ) GENERAL SUMMARY AND OVERVIEW STATEMENT: Supervised by the Financial Managed Care Supervisor, the Financial Managed Care Coordinator (FMCC) is responsible for obtaining appropriate insurance authorizations for patients with non-contracted insurances as well as for ambulatory, surgical or medication authorizations. The FMCC ensures patients have signed self-pay waivers, have the appropriate PCP referrals are in place, and ensures all non-contracted patients have been vetted and either authorized, self-paid, or referred to facilities in their network. The FMCC ensures payments for non-covered visits, procedures, coinsurance, deductibles are collected and posted in a timely manner. There is a high level of direct or phone patient/physician interface. PRINCIPAL DUTIES AND RESPONSIBILITIES Responsible for obtaining insurance approval and financial clearance for all related activities for BWH/PO financial clearance prior to initiation of patient services. Duties include but are not limited to verifying insurance eligibility and benefits, completing and communicating to patient their self-pay estimates, reviewing non-contracted payer insurance requirements, 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. Documenting financial clearance in the referral record or appropriate chart note. Working daily EPIC work queues and EPIC Inbaskets in an accurate and timely fashion. Financial clearance and authorization management includes the following, but is not limited to: Non-contracted patient financial clearance in EPIC Patient work queue Manages the A/FCC program, a collaboration between Boston Children's Hospital and BWH Maternal Fetal Medicine high risk obstetrics Center for Fetal Medicine high risk obstetrical consult program Family Planning patient financial clearance Works closely with BWH Financial Counselor regarding non contracted Medicaid ACOs Submits and ensures response on all self-pay BWH Patient Estimates Obtains prepayments in advance for services not authorized IVF Medication authorization for BWH, NWH and SSH Infertility sites Obstetrical and GYN Medication authorizations for OB/GYN Missing referrals Trouble shoot missing or mis obtained surgical authorizations Works closely with BWH Patient Estimate office on Self-Pay Patient Estimates and collections Ad hoc authorization requests and coverage as required. Ensures all service and medication requests are worked timely and timely insurance responses are received and information is shared with patients and clinicians. Works timely and accurately in EPIC patient work queues designed to stop scheduled visits with non-contracted insurances for review. Manages EPIC Inbaskets daily to review service authorization requests from clinicians. Meets weekly with F/MCC Supervisor to review progress, answer questions and provide payer adverse trends to the F/MCC Supervisor and participates in staff trainings and meetings. The F/MCC ensures all authorization tracking worksheets are completed each day with accurate information. The F/MCC serves as an advocate for patients, working with insurance companies and physicians in clinical review patient medical documentation, establishing peer to peer reviews when needed and treating patients with the utmost empathy and compassion. The F/MCC will advise the F/MCC Supervisor and Senior Billing Manager when single case agreements may be necessary to pursue. The F/MCC is also responsible for collection of non-covered services, deductibles, copays, coinsurances and to ensure appropriate 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. Responsible for ensuring insurance authorizations and referrals are received as required which may include working with the patient's primary care physician or patient to obtain a referral, providing education to practice staff 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 F/MCC requires comprehensive knowledge of insurance eligibility and benefits as well as the ability to navigate through payer policy and act as an advocate for patient approval. The F/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 to ensure services are authorized under the correct NPI. Responsible for handling all patients' billing inquiries made through the practice and resolve or triage the inquiry to the appropriate BWH/PO supervisor or manager if needed. Receives and expedites all incoming/outgoing telephone calls in a professional and courteous manner. High level of communication required between clinical team, insurance companies, patients, and BWPO management. Must be able to work as a team and collaborate and contribute to solving problems. Responsible for updating registrations, referral records and notifying billing team if patients report a change of insurance or change is discovered, reconciliation of authorizations for outpatient ambulatory, surgical and pharmacy services, as well as performing cross-coverage duties, as necessary, for other FMCCs, MCCs as well as the F/MCC Supervisor. The employee work area is always expected to be neat and clean. The employee is expected to adhere to the rules and regulations of the BWPO and BWH including but not limited the attendance and fragrance policies. Attends all required meetings and may attend ad hoc meetings dependent on subject matter. The employee must demonstrate initiative, independence and a willingness to learn new tasks. Customer service experience, required Four year college degree, preferred 1-3 years experience in health care setting and extensive knowledge of 3 rd party payers and billing requirements, preferred 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 Brigham and Women's Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, ancestry, age, veteran status, disability unrelated to job requirements, genetic information, military service, or other protected status. Primary Location MA-Brookline-BWH Brookline Hills BWPO Administration

Keywords: CTI Education Group, Brookline , Financial Billing Managed Care Coordinator/ 40 HOURS / DAY / OBGYN, Other , Brookline, Massachusetts

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