GENERAL SUMMARY/ OVERVIEW STATEMENT:

Working under the general direction of the Senior Billing Manager, the Managed Care Coordinator will help ensure that all professional radiation oncology charges are processed accurately by confirming a patient's insurance requirements are in place prior to treatment delivery. It is essential for the successful operation of the department that approvals are in place to maximize reimbursement. This may require obtaining a referral or an authorization for treatment. The Managed Care Coordinator may also assist in making sure that all the charges have been completed and coded properly. Any delay or error in the front-end process will cause insurance denials and disrupt cash flow. This position requires close attention to detail and will work daily with our Managed Care Supervisor along with the managed care teams at BWH & DFCI and the administrative personnel within our department.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Ensure correct patient demographic and insurance data is in ARIA and Epic.
• Verify patient insurance eligibility and assist in obtaining patient referrals/authorizations for services from physicians and/or insurance companies when necessary.
• Assist in rectifying denied claims (wrong insurance, no referral, bad address, wrong ID number, etc...)
• Assist with telephone inquiries and written inquiries from patients regarding their accounts.
• Utilize audit reports to identify patients with missing authorizations or discrepancies with their insurance coverage.

• Requests and reviews documentation for appeal to third party

• Reviews denied claims for possible appeal

• Communicates with third party carrier

• Deals with hospital, BWPO and outside organizations' personnel on managed care /contract issues.

• Utilizes on-line tools (i.e., NEHEN, carrier websites)

• Problem solves as required, updates management of critical trends, information and issue

Qualifications

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

- High School Diploma

- Prior experience in healthcare billing preferred.

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

- Strong computer skills necessary to handle a number of different routines and to understand complex patient accounts.

- Good communications skills to be able to interact with physicians, patients, insurance representatives, administrative contacts, etc.

- Ability to function independently with only general supervision. Displays initiative and uses good judgment.

- Need to be able to troubleshoot problems, develop workable solutions to problems, and to follow-up on problem resolution. Must be able to prioritize work and to handle multiple, sometimes conflicting, tasks using sound judgment.

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 basis of disability.