FINANCIAL ACCESS UNIT COORD.
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POST DATE 9/2/2016
END DATE 10/20/2016
Massachusetts General Hospital(MGH)
JOB DESCRIPTIONGENERAL SUMMARY/ OVERVIEW STATEMENT:
Reporting to the FAU Manager, the Financial Access Unit Coordinator (FAUC) ensures that patient demographic and financial information is complete in the hospitals registration and billing systems by working directly with the patient, physicians office, Patient Accounts and third party payers. The FAUC determines eligibility and obtains insurance authorizations and pre-certifications from third party payers for all types of admissions/procedures (i.e. surgical day care, inpatient, and observation). The FAUC assures compliance with payer regulations in order to generate revenue from various state, federal, and private insurance programs. The FAUC also acts as a liaison among patients, physician offices, case management, and third party payers ensuring that all third party payers requirements are met. The department goal is to maximize reimbursement while serving the needs of our internal and external customers. Responsible for supporting annual volumes of 100,000 patient accounts with approximately $3.5 billion in overall revenue.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
* Works as part of a group to secure 2,000 insurance authorizations with approximately $77 million in revenue per week. Obtains insurance authorizations for all elective and emergency admissions and procedures by providing necessary information as required by third party payers including Admit Worksheet, clinical, PCP referral etc. in an appropriate time frame. Understands notification requirements for date changes and status changes. Requires a complete understanding of coordination of benefits (which includes conducting the Medicare as Secondary Payer Questionnaire (MSP) with Medicare patients), third party payers and managed care plans.
* Ensures that patients demographic and financial information is complete and accurate for all elective and emergent admissions, day surgeries and bedded outpatient encounters. Required to verify patient eligibility and have knowledge of authorization process for various third party payers. Ensures that he/she has the most up-to-date information on any changes to insurance contracts and/or insurance authorization requirements.
* Expectation is to be able to provide charge estimates for patients inquiring about costs of procedures or cost sharing, at a volume of 5 requests per week. Uses complex cost estimator tools and forms to determine and inform patient of potential liability prior to admission. Fields daily phone calls from patients with insurance and cost related questions. Appropriately refers patients to and works as a team unit with Patient Financial Services for counseling if patient is unable to meet financial obligation.
* Informs patient and admitting physician of any potential health insurance authorization concerns prior to admission/procedure. Coordinates the authorization and approval process in full compliance with payer rules and regulations. Negotiates and orchestrates clinical conversations between MGH physicians and insurance company in order to get a procedure authorized for service. Works with practice staff to postpone and/or reschedule elective procedures if authorization cannot be obtained prior to date of service.
* Codes insurance authorization process status in Hurons OnTrac system and manages the workflow accordingly. As part of the group, touches 2,400 accounts per week. Documents and posts all required information in the hospitals registration and billing system in order for claim to be released and billing cycle to begin. Has an understanding of MGH Credit and Collection Policy. Reviews and works on Bill Hold daily and gives feedback to Supervisor of any difficult or unusual account.
* Researches and remediates rejections and denials to increase hospital revenue. Reviews first level rejections to determine area of fault. Thoroughly investigates payer denials and reports findings to supervisor on a weekly basis. Works closely with the Appeals Coordination Unit to identify trends and how to avoid future denials. Maintains a denial error rate of at or below 0.5% on a consistent basis.
* Responsible for accuracy and quality of individual work assignment, and a willingness to assist other team members validating the importance and value of team success. Responsible for maintaining a work productivity of at or above 100% and quality review that is at or above a 9.75 on a consistent basis.
* Incorporates new electronic and computer systems when needed (Epic, Huron, software, insurance eligibility, etc.) Able to undergo training for new systems while simultaneously balancing work productivity in current state systems.
* Acts as back up for other FAU teams as needed and performs other tasks as assigned by supervisor.
* Must be able to provide excellent customer service
* Ability to learn payer and department policies and regulations quickly, and be able to incorporate them into the daily activities while maintaining a smooth operation
* Ability to communicate effectively and in a sensitive manner with patients and hospital staff via phone, in person or in writing
* Must possess excellent organizational and prioritizing skills with the ability to multitask
* Ability to problem solve, work under pressure and under very tight deadlines
* Energetic team player with positive attitude
* Adequate typing skills (30WPM) and familiarity with computers ( Microsoft Outlook, Word, Excel, internet)
* Bilingual in English and another language a plus
* Bachelors Degree required
* Equivalent experience a plus
* Prior work experience in hospital or other healthcare environment (preferred)
* Knowledge of third party payers
* Knowledge of ICD-9 and CPT coding a plus
* Medical terminology (preferred)
* Willingness to continually learn and grow as a member of a Team and Department
The right candidates have a positive attitude, quick mind, and thrive with working under strict time-lines. We are looking for fast learners of public insurance eligibility regulations to ensure reimbursement so that MGH can continue to provide the highest quality of care in the industry for our patients. We will gladly train the right candidate.
Most of the work is performed within the MGH Admitting Department with very little face-to-face patient interaction. 90% of work is done seated, at computer. Requires light physical effort on a regular basis, as in frequent sitting, standing, walking, bending or reaching . Work area is single occupied cubicle, which can be considered somewhat cramped. Noise level is moderate to high due to shared work area. Occasional local travel may be required.
* Bachelors Degree required
* Equivalent experience a plus
Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged