BWPO Financial Managed Care Supervisor / 40 Hours / Day / OBGYN

The Financial Managed Care Supervisor oversees the patient service revenue financial clearance operations for the Department of OB/GYN's non-infertility clinical divisions. 

The F/MCC Supervisor reports directly to the BWPO OB/GYN Managed Care Manager and is responsible for the direct supervision of three (3) Financial Managed Care Coordinators dedicated to financial clearance management of all OB/GYN department patients. The F/MCC Supervisor will ensure adequate team staffing and training and participates in staff hiring and performance reviews. The F/MCC Supervisor oversees the F/MCC team's deposit functions and is the first interface with patients regarding billing questions.  

The F/MCC Supervisor is responsible for ensuring financial clearance of all patients including but not limited to eligibility, benefits, BWH/PO authorizations, referrals, medication authorizations, self-pay estimates and collections, non-covered service cash collections and ad hoc authorizations and financial management as needed Additionally, the F/MCC Supervisor will work closely with BWH/PO clinic management and administrative staff, the International Patient Center, the BWPO Billing team, OB/GYN Finance, BWH patient accounts managers, and any outside agency transferring patients to BWH/PO.

PRINCIPAL DUTIES AND RESPONSIBILITIES INCLUDE: 

Under the direction of the BWPO OB/GYN  Managed Care Manager, the F/MCC Supervisor is responsible for managing F/MCC daily operations including but not limited to patient service authorizations for the Brigham and Women's Hospital Department of OB/GYN non CIRS divisions i.e., The Center for Fetal Medicine, Genetic Counselor and lab testing, medication authorizations, Gynecological authorizations in the Family Planning division, ad hoc authorization requests as determined by the BWPO Managed Care Manager. 

Directly responsible for all authorized services as required by the payers, including but not limited to ensuring patient financial clearance for the following areas:

         Non-contracted patient financial clearance

         MFM AFCC and CFM program financial clearance

         Family Planning authorizations and patient financial clearance

         Infertility Medication Authorizations for BWH and NWH Satellite

         All divisions Medication Authorizations i.e, obstetrics and gyn practices

• Surgical authorizations for Health Center physicians
• Self-Pay Patient Estimates and collections
• Works closely with Patient and BWH Patient Estimate office
• Obtains prepayments in advance for services not authorized
• Troubleshoots missing referrals
• Manages Surgical authorizations for OBGYN
• International Self-Pay collections
• Running reports to identify trends or areas of improvement
• Identifying and communication of trends aimed at minimizing denials and write offs.
• All appropriate self-pay waivers and contracts are signed and scanned into EPIC Media
• Ad hoc authorization requests as required.

Responsible for the coordination of onboarding, training, hiring, mentoring and supporting of new F/MCC staff including but not limited to, EPIC training, payer website access and training, verifying insurance eligibility, documentation of insurance benefits/authorization, obtaining insurance approvals, surgical case authorization management, assisting physicians with peer to peer review, review of cases for lab updates prior to authorization submission, managing case submissions are timely, communications with patients about their lab updates or approvals/denials, the collection of non-covered services, coinsurances, deductibles and mastered knowledge of payer websites and payer policies related to authorization of services. 

Ensures all requests are worked timely and timely insurance responses are received.  Meets with F/MCC team independently and review progresses, answer questions and provide ad hoc training as needed.  Communicates appropriate directives to the F/MCC team and prepares meeting agendas for monthly F/MCC meetings.

Responsible for implementing policies and procedures set forth by the Managed Care Manager in supervising existing and new operational and financial initiatives for OB/GYN patient financial clearance.

Directly responsible to ensure all patient prepayments are collected, managed, and refunded if required in a timely manner. 

Works closely with F/MCC to assist with explanation of financial responsibilities, high level questions regarding benefits, eligibility, authorization of difficult cases, or claims/billing problem resolutions.

Responsible for ensuring that the highest quality customer service is provided to all patients.  Monitors that the Financial Managed Care coordinators are expediting all incoming/outgoing telephone calls in a professional and courteous manner. 

Requires a strong working knowledge of the EPIC billing system, payer websites, insurance payment policies, ability to explain fee structures and complex billing issues to patients for various treatment options and all other special programs. 

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.

Investigates and resolves all patients' non CIRS complex billing problems and inquiries and working with and triaging to the Partners' Patient Accounts, Departments, billing to resolve problems. 

Works alongside OB/GYN ambulatory clinic practice and nursing staff to train new and existing employees regarding insurance rules, regulations and non-contracted payers, as well as authorization submission processes.

Ensures F/MCC team are in accordance with BWH/PO policies and procedures, specifically the attendance and fragrance policies.

Attends all required meetings and may attend ad hoc meetings dependent on subject matter. 

Assists in identifying issues, trends and efficiencies to enhance the revenue cycle, prior authorization, denial reduction processes, or reduce redundancies.

Reconciliation of authorization for surgical outpatient procedures.

Performs backup duties, as necessary, for the F/MCC financial management team as well as the CIRS Managed Care Supervisor.   

• 4 years of Managed Care Coordinator experience required
• Four-year degree or equivalent work experience required
• 3 years of Supervision experience preferred
• Customer service experience required
• Experience in health care setting and knowledge of 3rd party payers and billing requirements, 5 years required
• Excellent interpersonal skills
• Excellent written and oral communication skills
• Accuracy, with attention to detail
• Ability to work both independently and as part of a team
• Good computer and software skills
• Ability to work under pressure, multi-task and meet deadlines