GENERAL SUMMARY/ OVERVIEW STATEMENT: Summarize the nature and level of work performed. Please note that this section should be written in a paragraph format and provide a broad description of the role and its purpose as well as the reporting structure.

Brookside Community Health Center, licensed by Brigham and Women's Hospital, provides multi-disciplinary, comprehensive care with services in Adult Primary Care, Pediatric Primary Care, Obstetrics/Genecology, Family Planning, Dentistry and Oral Surgery, Nutrition/WIC in addition to Behavioral Health and Social Services to a very diverse patient population in Jamaica Plan and surrounding areas. The Float Senior Practice Assistance, under the supervision of the Administrative Director, provides general administrative support in a high-volume ambulatory setting, functioning as an interface between the care team and the patients. The emphasis is placed on supporting the Managed Care Team, Financial Counselors and Media Senior Practice Assistance.

PRINCIPAL DUTIES AND RESPONSIBILITIES: In order of importance, list essential 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. This section should be completed as a bulleted list and explain how the role is performed.

Provides back-up coverage to the Billing Managed Care, the Patient Business Representative, and Media Senior Practice Assistance.

Billing /Managed Care

• Medical, DME and Radiology Prior Authorization

• Answer authorization requests via phone or fax.

• Verify the provider, check benefits, and determine if a referral is necessary before setting up the authorization.

• Perform review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.

• Handle initial screening from physicians/members via incoming calls or in-basket under the oversight of clinical staff.

• Prepare, document and route cases for clinical review.

• Initiate call backs and correspondence to members and providers to coordinate and clarify benefit

• Obtains insurance verification and prior authorizations as necessary

Patient Business Representative

• Assists uninsured and underinsured patients with financial assistance, including screening for eligibility for Medicaid or other government programs, assisting patients in completing Medicaid or free care applications. Acquaints patients with the hospital's financial policies and requirements.

• May conduct interviews with patients at health center.

• Submits completed Medicaid applications to the Massachusetts Division of Medical Assistance. Follows-up on all submitted applications, assuring compliance, and acts as a liaison between patients, health center staff and government agencies in an effort to obtain approvals in a timely manner.

• Screens and assesses the ability of patients to pay for services. Uses computer systems (ADO/AR) to ensure all free care eligibility data. Rebills as necessary.

• The financial counselor may:

o work closely with BWH departments (accounts receivable, ambulatory registration, care coordination, admitting, legal, etc.) to indicate patients' insurance status and to resolve patient account issues.

o provide assistance to patients in researching outstanding accounts and troubleshoots problems with billing questions within the accounts receivable system.

o arrange payment plans with patients and billing office.

• Ensures information is available for Medicaid, tracking and reporting and ensures data integrity.

• In addition, the financial counselor may:

o register patients for visit

o verify patient insurance for all visit

o collect and document all payment

o oversee daily cash out including nightly batch out

o have responsibility for cash drawer

o do daily bank deposits

o assist in managing center-wide petty cash system

o assist with printing and confirmation of encounter

o send new patient letter

Media Senior Practice Assistance

• Responsible for medical records management to include filing, scanning, chart preparation, and release of medical information in accordance with HIPAA.

• Provide medical information to authorized individuals following HIPAA regulation

• Running critical document checks to ensure all files have been saved as necessary

• Importing electronic documents, including scanning documents into the document management system.

• Retrieve medical records or reports from other institutions unaffiliated with MGB

• Maintaining an organized and secured workstation and filing area

• Manage all forms and paperwork coming into Brookside by all patients. Will organize, upload/scan and notify appropriate individual of follow-up needed.

• Monitor form completion and follow-up with relevant staff if not completed

• Upload completed forms in media tab and notify relevant staff and patient that document is available for pick-up.

• Create telephone encounter for each form that serves as a monitoring and tracking system to ensure form completion.

• Upload medical necessity letters and prior authorizations for durable medical equipment in Media tab

• Cover main reception desk and phones as needed.

• Prioritize customer services in managing all assigned task

• Send outside records to MGB by fax.

• Retrieve records from the warehouse if necessary.

• Respond to patents in a timely manner, with follow up steps.

• Maintain confidentiality and privacy consistent with HIPAA guidelines.

• Provides administrative support to providers including correspondence on behalf of physician.
• Works collaboratively with health center staff to create efficient systems regarding medical records, form management and patient communication.
• Performs other tasks as assigned and as appropriate to this position.

SKILLS & COMPETENCIES REQUIRED: This section should be a bulleted list of minimum requirements explaining the skills (what the individual is trained for) and competencies (measurable as defined by the job) necessary to perform the job.

• Must be bilingual speaking languages English and Spanish.

• Excellent organizational skills with strong attention to detail and time management skills.
• Possesses knowledge of HMO, manage care and other third-party insurers.
• Understands financial services and self-pay resources and provides patients with information as needed.

• Ability to work collaboratively and independently.

• Demonstrates initiative and continually strives to enhance the credibility of the department.

• Takes ownership and responsibility for work and behavior.

• Ability to problem solve and function as a resource to other members of the team and resolve complex issues on behalf of the providers and patients.

• Seeks guidance and direction appropriately.

• Ability to multi-task, prioritize effectively and exhibit composure in a fast-paced environment.

• Ability to effectively evaluate all aspects of a situation and independently make appropriate and timely decisions.

• Exceptional written and oral communication skills; ability to communicate concisely.
• Strong ability to use discretion in protecting confidential information and seeking guidance when needed.
• Ability to learn new software quickly and effectively
• Ability to "think outside the box" to solve problems while working within policies and procedures of a large healthcare organization.
• Ability to work independently and as part of a team.
• Familiarity with medical terminology.
• Computer skills.
• Excellent client service skills
• Can-do attitude and flexible approach

• Knowledgeable and compliant in all hospital, state and federal regulatory requirements, including hospital policies and procedures (where applicable to the job), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Health Insurance Portability and Accountability Act of 1996 (HIPAA).

LICENSES, CERTIFICATIONS, and/or REGISTRATIONS: Specify minimum credentials and clearly indicate if required or preferred.

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003900000001000000000000000000000000000000000000000000 Not Applicable

Licenses:



Required:



Preferred:

Certifications:



Required:



Preferred:

Registrations:



Required:



Preferred:

EDUCATION: Check boxes that best describe the minimum and preferred education requirements.

Minimum Required:

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003100000001000000000000000000000000000000000000000000 High school diploma, GED or equivalent

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003100000000000000000000000000000000000000000000000000 Certificate: FORMTEXT Please specify FFFFFFFF000000001400000000000E0050006C0065006100730065002000730070006500630069006600790000000000000000000000000000000000000000000000

FORMCHECKBOX FFFFFFFF650000001400070043006800650063006B0032003600000000000000000000000000000000000000000000000000 Some college or Associate's Degree

FORMCHECKBOX FFFFFFFF650000001400070043006800650063006B0034003000000000000000000000000000000000000000000000000000 Bachelor's Degree

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003900000000000000000000000000000000000000000000000000 Master's Degree

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003900000000000000000000000000000000000000000000000000 Doctoral Degree

FORMCHECKBOX FFFFFFFF6500000014000000000000000000000000000000000000000000000000000000 None required

Preferred:

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003100000000000000000000000000000000000000000000000000 High school diploma, GED or equivalent

Certificate: Administrative Assistant or Secretarial Training Program Certificate desirable

FORMCHECKBOX FFFFFFFF650000001400070043006800650063006B0032003600000001000000000000000000000000000000000000000000 Some college or Associate's Degree

FORMCHECKBOX FFFFFFFF650000001400070043006800650063006B0034003000000000000000000000000000000000000000000000000000 Bachelor's Degree

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003900000000000000000000000000000000000000000000000000 Master's Degree

FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003900000000000000000000000000000000000000000000000000 Doctoral Degree

EXPERIENCE: Indicate the required and preferred (optional)amount and type of experience.

FORMCHECKBOX FFFFFFFF6500000014000000000000000000000000000000000000000000000000000000 Not Applicable

• Minimum 2-4 years clerical/administrative experience in a healthcare setting, or related experience with transferrable skills preferred.

SUPERVISORY RESPONSIBILITY (authority to hire, promote, or terminate): Indicate supervisory "scope" and list the number of employees supervised.

FORMCHECKBOX FFFFFFFF6500000014000000000001000000000000000000000000000000000000000000 Not Applicable

FISCAL RESPONSIBILITY: Indicate financial "scope" information, e.g. size of budget, volume, revenue, etc.

FORMCHECKBOX FFFFFFFF6500000014000000000001000000000000000000000000000000000000000000 Not Applicable

WORKING CONDITIONS: Describe the conditions in which the work is performed. Use this section to detail any physical requirements for the position (lifting, carrying, etc). Use this section to also detail any environmental conditions associated with the position (outdoor weather requirements, hazardous materials, etc).

• High-volume ambulatory office setting

The information contained in this document is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of individuals so classified.

Qualifications

High school diploma, GED or equivalent

EEO Statement

MGB 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.