Practice Assistant II

About Brigham and Women's/Mass General Health Care Center:

Brigham and Women's/Mass General Health Care Center is a comprehensive, community-based, multi-specialty ambulatory care center located in Patriot Place, a retail lifestyle center located adjacent to Gillette Stadium in Foxborough, Massachusetts. The Center offers a wide range of ambulatory services including Day Surgery, Urgent Care, Primary Care, Medical and Surgical specialties, as well as comprehensive ancillary services: Pharmacy, Clinical Laboratory Services, Phlebotomy, and a wide range of Diagnostic Imaging services. This deep breadth of patient services under one roof requires that each of our team members embody the willingness and ability to work across departments in order to provide an integrated patient experience.

While the Center's location is 25 miles from the main campus of BWH, it is an expectation that the Center's services offered will comply with the standards of care found at our main campus. In addition, all physicians practicing at the Center will be fully credentialed at BWH and will provide the same excellence of care that makes the BWH nationally recognized for clinical excellence. The administrative and clinical staff of the Center must demonstrate the same high level of competence and professionalism found at the main campus. Travel to main campus may be required for professional development or business reasons.

Expectations for all Brigham and Women's/Mass General Health Care Center Employees:

Each employee is responsible for understanding the importance of and contributing to creating an environment that puts Patients First. To that end, all Center employees are expected to:

Ø Work in an efficient manner

Ø Practice safe patient care

Ø Practice multi-disciplinary cross-coverage duties as needed

Ø Work effectively in a team environment

Ø Demonstrate a consistently high level of professionalism

Ø Provide excellent, consistent customer service

Ø Be flexible

Ø Be willing to participate in changes to improve the Patient First environment.

These eight expectations are key to the Center's success and are core competencies required by all Center employees, regardless of role.

This Practice Assistant/Managed Care Coordinator position is an integral member of the Pain Management Center (PMC) healthcare team in Foxborough and is accountable for Prior-authorizations for all procedures and medications. The role will provide prior authorization support to the Pain Management practice in Foxborough, responsible for multiple functions to ensure a smooth and seamless patient experience.

Job Specific Duties and Skills for position:

JOB SPECIFIC 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.

1.Perform duties under moderate supervision with intermediate to advanced proficiency in procedure prior authorizations.

2.Demonstrates patience, understanding and compassion when working with the challenging population of chronic patient patients.

3.Schedule patients for appointments/procedures, confirm appointments/procedures, prepare for patient visits by providing patient with all necessary information and completing all necessary tasks.

4.Identifies urgent high risk medical problems during patient calls and obtains appropriate clinical support from nursing or attending physician.

5.Participates in prescription management tasks: working with nurse/physician for prescription refills and renewals requiring LIP approval and prior authorizations.

6.Identify missing or incomplete clinical orders, needed for scheduling purposes.

7.Assist with special projects as directed.

8.Follow HIPAA guidelines for the management of patient privacy and confidentiality.

9.Appropriately utilizes organizational resources including management of time, supplies, equipment and other assets.

10. Position will require certification in BLS (Basic Life Support).

11. Provide cross coverage for check-in/check-out, surgical scheduling

12. Other duties as assigned.

Managed Care Responsibilities:

13. Utilize knowledge of HMO's, managed care and other third-party insurers, and troubleshoots insurance issues as appropriate.

14. Checks schedules for referrals and contacts Patient Service Center for missing referrals.

15. Works closely with physicians and case managers to provide timely documentation for workers compensation patients including responding to denials and the appeals process.

16. Obtains all referrals/prior authorizations for procedures for all insurance companies and workers compensation. Works closely with clinic staff and lead biller, specifically for denials.

17. Coordinates peer to peer reviews with the insurer and provider when a request for a procedure is denied.

18. Educates patients being seen in Foxborough regarding PMC referral/authorization requirements. Serves as patients' primary contact within the Pain Management Center for understanding insurance requirements, worker's comp and prior approval processes. Makes calls to patients to inform them of approval or denial for procedures.

19. Works with the providers to ensure that patients' medical documentation complies with insurance requirements.

20. Responsible for educating staff about changes in managed care and other insurance requirements.

21. Responsible for all medication prior authorizations.

22. Assists PMC Lead Biller with denials work queue.

23. All other duties as assigned.

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

1.Excellent interpersonal skills. This position requires a great deal of initial contact with customers' objectives.

2.Superior customer service skills.

3.Expert knowledge of referral management, prior authorizations and insurance parties/eligibility.

4.Excellent organizational skills.

5.Computer literacy/data Entry skills.

6.Ability to prioritize work in a very busy atmosphere.

7.Familiarity in a hospital/ambulatory care setting.

8.Ability to problem-solve independently.

9.Capable to work quickly to resolve or minimize identified problems.

10. Pain Management prior authorization experience preferred.

QUALIFICATIONS:

• High school diploma or GED required; post-high school education preferred.

• Minimum one year of applicable work experience required.

• Additional training in office systems preferred.

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:

• Knowledge of practice operations and standards.

• Understanding of procedures including filing, copying, scanning, printing, and faxing.

• Ability to use phone system (answer and screen calls, put on hold), answer routine questions, and give routine information.

• Ability to interpret information as appropriate, answer routine questions in the most professional manner, and communicate in a professional, courteous, clear, and concise manner.

• Ability to manage work processes in a neat and orderly way and to sort and alphabetize.

• Ability to manage multiple tasks effectively, follow established protocols, and work within systems.

• Ability to correspond and communicate with others clearly and effectively in writing (via e-mail, memo, or interoffice note) and to take complete and accurate messages.

• Ability to type and enter data at an entry level. Entry level understanding of applicable systems.

• Understanding of the appropriate use and importance of related forms.

• Basic understanding and use of medical terminology.

• Basic comprehension of insurance types and referral process.

• Basic comprehension of registration and fiscal information.

• Knowledgeable and compliant with all hospital, State, and Federal requirements (where applicable to job performance), including policy and procedures with The Joint Commission and HIPAA.

WORKING CONDITIONS:

Hospital based ambulatory practice. Normal patient environments where there are some exposures to communicable diseases, unpleasant odors, needle, and blood products.

HOSPITAL WIDE RESPONSIBILITIES:

Works within legal, regulatory, accreditation and ethical practice standards relevant to the position and as established by BWH/Partners; follows safe practices required for the position; complies with appropriate BWH and Partners policies and procedures; fulfills any training required by BWH and/or Partners, as appropriate; brings potential matters of non-compliance to the attention of the supervisor or other appropriate hospital staff.