BWPO Managed Care Coordinator / 40 Hours / Day / OBGYN

GENERAL SUMMARY AND OVERVIEW STATEMENT:  Supervised by the Lead Managed Care, the Managed Care Coordinator is responsible for obtaining appropriate insurance authorizations, referrals and payments for all patient visits and procedures as well as collection of patient service coinsurance, deductibles and self pay revenue for the Department of OB/GYN Center for Infertility and Reproductive Surgery.  There is a high level of direct or phone patient/physician interface.

*This is a fully remote position, must live in Massachusetts and be able to travel to Boston for training.

PRINCIPAL DUTIES AND RESPONSIBILITIES

1. Responsible for daily reviewing their EPIC inbaskets for pending authorization requests and for obtaining insurance approval for all related activities for Brigham Center for Infertility and Reproductive Surgery and Satellite operations, prior to initiation of patient services.  Duties include but are not limited to verifying insurance eligibility and benefits, reviewing clinical notes and lab tests to gather information for insurance approval, timely completion of insurance authorization forms, submitting authorizations to insurance and ensuring receipt and timely response, documenting in patient chart, establishing episodes of care, launching scribes in ARTSITE and reviewing their daily FAXCOM folder for updates on faxes received/sent.

1. Explaining insurance coverage to patients, accurately advising patients regarding outstanding lab work and procedures that are required prior to authorization submission.  The MCC documents in EPIC as notification to the clinical staff patients who have not completed the required testing for insurance approval.  The MCC also is required to verify cycle starts, review charts, scan records and communicate on all billing matters to the BWPO Billing Office.

1. The MCC is also responsible for ensuring appropriate referrals are on file for the treatment cycle as well as 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 of prepayments in the EPIC billing system. 

1. The MCC is responsible for ensuring understanding of global versus fee for service cases, as well as ensuring the authorizations obtained contain the correct billing codes, either S codes for global insurances or CPT codes for non-global insurances.  All authorizations must be documented in the billing episode by code.

1. Responsible for ensuring insurance authorizations and 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, providing education to practice staff to 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.

1. The Managed Care Coordinator is responsible for the accurate and daily creation of patient episodes once authorization is obtained, ensuring that the correct episode type is used and correct billing codes have been documented in the episode comments along with appropriate services, dates, and approval numbers. 

1. The MCC is responsible for timely launching patient scribes in ARTSITE, emails to the BWH CIRS team as needed regarding patient financial clearance, scanning authorization requests and corresponding insurance approvals in the RMS electronic filing system as well as overall financial clearance of the patient.

1. The Managed Care Coordinator is responsible for the daily start list, daily approval list, as well as the daily verification of insurance eligibility and benefits of the physician's clinic schedule to ensure patients are covered for services.  All findings are documented in EPIC for clinic view of necessary information and communicated to Lead Managed Care if needed. 

1. Responsible to report trends in authorization denials, insurance website issues, operational issues and patient complaints to the Lead Managed Care Coordinator.

1. The MCC requires comprehensive knowledge of insurance eligibility and benefits as well as be able to navigate through payer policy and act as a champion for patient approval.

1. The MCC ensures patients have signed self pay waivers and contracts when appropriate and understands the refund process and the BWH/PO billing model. The MCC is responsible for explaining fee structures to patients for various treatment options and all other special programs and ensures signed documents are scanned into the electronic filing system (RMS).

1. Responsible for handling all patients' billing inquiries made through the practice and resolve or triage the inquiry to the appropriate BWH Account specialist.  Also, responsible for working with OBGYN billing and analytical staff to ensure appropriate authorization is on file prior to billing patient's treatments and/or updating authorizations, and contacting patients if benefits/plan has changed post treatment.

1. 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.  Must be able to work as a team and collaborate and contribute to solving problems.

1. May also be responsible for determining and entering charges into the BWPO physician, communicating appropriate information to BWPO, updating registrations and notifying billing team if patient's report a change or change is discovered, as well as performing cross-coverage duties, as necessary, for other Coordinators as well as the Managed Care Supervisor.

1. The employee work area is expected to be neat and clean at all times. 

1. The employee is expected to adhere to the rules and regulations of the BWPO and BWH

1. The employee must demonstrate initiative, independence and a willingness to learn new tasks. 

Customer service experience, required

Four-year college degree, preferred

1-3 years experience in health care setting and extensive knowledge of 3rd party payers and billing requirements, preferred

Intermediate knowledge of third-party payers

Excellent interpersonal skills, written and oral communication skills

Accuracy, with attention to detail

Ability to work both independently and as part of a team

Computer skills, including word processing, data entry, and knowledge of EPIC billing system a plus

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

Familiarity with common office equipment