Bwpo Billing Managed Care Coordinator / 40 Hours / Day / Ob/Gyn

Brigham And Women's Hospital Brookline , MA 02445

Posted 3 days ago

PRINCIPAL DUTIES AND RESPONSIBILITIES
1.Responsible for obtaining insurance approval for all related activities for Brigham and Satellite operations, prior to initiation of patient services. Duties include verifying insurance eligibility, benefits and ensuring and/or reviewing referral reports to verify active referrals on file for each patient visit. Completing and (upon physician approval) physician treatment plans in their entirety and accurately to insurance companies to obtain financial clearance.

  • Responsible for 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 in the billing system of collected patient service revenue.

  • Explaining insurance coverage to patients, advising patients and staff of patients who do not have approval to start medications, obtaining written pre-certification when necessary, verifying cycle starts as required, pull charts, scan records and communicating and acting as liaison to BWPO Billing Office and OBGYN Satellite facilities, as well as Partners' Patient Accounts and other physician billing offices as necessary. Requires detailed knowledge of insurance requirements and close attention to patient scheduled appointments since each insurance company has different treatment plan requirements.

  • Responsible for ensuring patients have signed self pay waivers and contracts when appropriate, understand the refund process, 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.
    5.The Managed Care Coordinator is responsible for the daily start list verifications, daily approval list emails to the BWH CIRS team, ART Option emails, scanning authorization requests in the RMS electronic filing system as well as launching scribes in ARTSITE after financial clearance has been obtained.
    6.Responsible for handling all patients' billing problems and inquiries, and working with and triaging to the Partners' Patient Accounts, BWPO physician billing offices, Satellites and Brigham Surgical Billing Service to resolve problems. Also, responsible for working with BWPO OB/GYN Billing Analysts and Billing Vendor in the resolution of unpaid claims.

  • Responsible for ensuring insurance 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, obtaining referrals using the POS device, educating secretarial 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.

  • 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.

  • Might be responsible for determining and entering charges into the BWPO physician or BWH Hospital billing system. Also responsible for communicating appropriate information to BWPO as necessary. Might be responsible for registration duties including but not limited to reporting patient's change in registration to the billing vendor and to BWH registration, as well as editing patient demographic and fiscal information.

  • Performs cross-coverage duties, as necessary, for other Coordinators as well as the Managed Care Supervisor.

QUALIFICATIONS

  • 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 AND ABILITIES

  • Excellent interpersonal skills

  • Excellent written and oral communication skills

  • Accuracy, with attention to detail

  • Math/Financial experience

  • Ability to work both independently and as part of a team

  • Computer skills, including word processing and data entry

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

  • Familiarity with common office equipment

Pleasant, but active, office environment

QUALIFICATIONS

  • 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 AND ABILITIES

  • Excellent interpersonal skills

  • Excellent written and oral communication skills

  • Accuracy, with attention to detail

  • Math/Financial experience

  • Ability to work both independently and as part of a team

  • Computer skills, including word processing and data entry

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

  • Familiarity with common office equipment

Pleasant, but active, office environment


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Bwpo Billing Managed Care Coordinator / 40 Hours / Day / Ob/Gyn

Brigham And Women's Hospital