Patient Services Coordinator III/Billing 8/19/2016
Massachusetts General Hospital(MGH)
JOB DESCRIPTIONThe Patient Services and Billing Coordinator, under general direction of the Operations Manager, provides administrative support to health care providers in a high-volume Gastroenterology ambulatory practice, functioning as the primary liaison between the patient and the providers. The emphasis is placed on the ability to organize priorities, complete tasks, manage confidential patient information, schedule patient appointments, diagnostic testing, referrals and other managed care related issues. Responsible for obtaining prior authorizations and referrals, processing encounter forms and financial waivers, and patient billing issues. Responsible for the accounts payable for the clinical practice. Ensures accuracy and completeness of all Divisions patient billings and clinical encounter. Follows through with patients, practices, providers and back end. Assist Manager with projects and research as needed.
Coordinates the scheduling of multiple appointments for patients seeing Gastroenterologists, and / or seeking Endoscopy Procedures. Maximize efficiency and capacity of schedule. Schedules patient appointments and creates referrals for specialty visits and diagnostic testing, as required. Coordinates the scheduling of diagnostic testing.
Performs all check-in and -out functions, as outlined by the MGH/MGPO Front Desk Standards of Operations. Receives and responds to internal and external telephone calls from patients, caregivers, coworkers and other departments. Triage calls and takes messages and assists patients and families with problem resolution both in-person and over the telephone.
Understands financial services and self-pay resources and provides patients with information as needed. Understands all HMO, Managed Care and other Third Party Insurers. Functions as a resource for patients around managed care plans, insurance and referral issues, with an ability to perform electronic insurance verification.
Completely performs and is a resource to other team members in all revenue enhancement activities, including but not limited to registration verification, co-payment collection, cash management, encounter form reconcilement, etc.
Monitors EPIC encounter completion and works closing with providers to ensure timely completion of notes and billing.
Reviews schedules to ensure all patients scheduled have appropriate insurance, authorizations and referrals in place. Creates financial waivers for patients in endoscopy and clinic as needed.
Obtains prior authorizations and referrals for all patient office and endoscopy visits in the Division in a timely fashion.
Works close with the Division leadership and MGPO billing office to ensure all providers are properly enrolled with payers and that claims are processed from the division in a timely manner.
Answers Hospital and PO billing questions regarding encounters and follows-up on any that are returned.
Maintains reports from MGPO and Hospital denials and claims that require further review and documentation.
Requests for bills from attorneys and insurance companies are received, checked for MRN and sent to Customer Service in Charlestown.
Ability to check EPIC for researching billing. Understands billing and the meaning of various entries into EPIC.
Ability to track billing issues and follow cases through all of the billing screens. Brings patterns of problem areas to the supervisor's attention for follow up or direction.
Ability to read Master Charge lists and estimates a visit for patients.
Is trained and capable of doing full registrations, updating demographic, insurance, PCP and global updates in PCIS.
The individual communicates educational information regarding carriers and billing with staff to ensure clarity and appropriate next steps.
Ability to work with co-workers and direct some of the department's quality work.
Continues to educate staff regarding billing/carrier payment/rejection processes.
Works with patients to resolve billing problems that Customer Service area were not able to resolve.
Process accounts payable transactions for the division, including purchase orders, invoice payments, etc.
Respects patient confidentiality at all times.
Provides excellent customer service to both internal and external customers.
Contributes to the teamwork within and between departments. Provides constructive ideas, suggestions and feedback in a positive manner. Works collaboratively with coworkers to effectively resolve issues that impact departmental or hospital operations.
Participates in project work and other duties as assigned.
High School Diploma or Associates Degree
Excellent computer and typing skills
Ability to use EPIC
Attention to detail
Ability to work quickly and accurately
Ability to stay focused and maintains energy level
Ability to work with co-workers, providers, patients and outside agencies
Ability to work with difficult patients
Ability to exercise judgement in dealing with sensitive, confidential information
Strong interpersonal and communication skills
Exceptional customer service skills
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.