Lead Billing Managed Care Coordinator, Clinical Neurology

Under the direction of the Finance Director and in coordination with the Practice Administrator, the Lead Managed Care Coordinator is responsible for supporting the front and back-end revenue cycle processes for the Department of Neurology. The incumbent will be responsible for:

Lead Role Managed Care Responsibilities:

- Oversee day to day operations / workflow for managed care coordinators (4) approx..

- Provide input and/or feedback for performance evaluations to Practice Administrator

- Direct point of contact for managed care staff regarding billing questions, insurance updates, Serves as Subject Matter Expert for Neurospych testing and Botox authorization process.

- Department Appointment Review (DAR) Mgmt

- Establishes and develops collaborative relationships with internal staff. Works with neurology leadership to modify procedures and update information (i.e. update practice level pick lists, billing instructions). Shares information with MCC staff to enhance departmental efficiency/performance.

- Assists Practice Administrator (PA) with the Development of standardized approaches for operational issues, reporting, and analysis and quality management. Reviews key measures on a regular basis and develops new measures as needed. Develops expertise in querying system for data and reports. Works closely on interface and system issues as required to improve flow of data.

- Monitors practice activity utilizing the EPIC Dashboard and workbench reports. Ensures that denials are worked within a timely fashion as deemed appropriate.

- Meets established service standards and works with the managed care team to efficiently resolve denied claims.

- Attends all department and Practice meetings as required.

Performs the duties of the Managed Care Coordinator, including, but not limited to:

* Serving as a liaison to patients and insurance companies to provide them with all necessary information in order to obtain prior authorizations for office procedures

* Ascertain work related visits and cases; obtain all necessary worker compensation information necessary to initiate and complete negotiations and billing.

* Complete referral management process in conjunction with Patient Service Center, including reviewing, updating and completing any missing information.

* Ensure that referrals obtained for all clinic visits are up to date and accurate.

* Perform demographic and insurance eligibility checks in Epic, Nehen, and Emdeon. Review and correct any information that is found through eligibility checks.

* Work with Billable Care Providers, Billing Manager/Liaison, and Finance Director to ensure charges are going out appropriately.

Front-End Managed Care Responsibilities:

- Supports the Department's revenue cycle initiatives through the centralized management of procedural authorizations and referrals for care provided in the outpatient setting aimed to maximize revenue and assist in the quality of the patient experience.

- Scans provider schedules for any non-contracted plans to escalate to Practice Manager

- Facilitates Referrals and Prior Authorization requests to all payers and specialty pharmacies through use of faxcom, telephone, and online portals

- Works closely with the BWH patient registration team, third party payors, Department of Neurology billing team, DON administrative support teams, and other BWH representatives involved in the revenue cycle to ensure the correct patient demographic and insurance information is present in BWH scheduling system (EPIC); updates demographics as needed; refers patient to BWH registration team to update fiscal information as needed.

- Works closely with the Finance Director and Practice Administrator on identifying revenue cycle process improvement opportunities and enhanced practice efficiency/communication.

- Works closely with internal ordering physicians, practice managers and staff to obtain the necessary procedural orders and documentation to support procedural authorization requests.

- Communicates directly with and educates patients on their role and responsibilities in obtaining medications from specialty pharmacies needed to support the procedural care in a timely manner.

- Completes the authorization processes with the third-party payors and communicates with patients and/or practice support staff regarding the status of such authorizations; maintains tracking mechanism for efficient management and communication of the authorization statuses.

- Clearly documents all referral and authorization details in the electronic scheduling and medical record system (EPIC).

Back-End Denial Management Responsibilities:

- Works the missing referral/authorization denial work que to find resolutions to payment discrepancies and coordinate with the billing team for conducting appeals

- Maintains close communication with the practice management team and Department's professional billing staff in order to re-process claims in a timely manner.

- Works closely with the Director of Operations and Practice Administrator on identifying referral management process improvement initiatives.

Performs all other duties as assigned

This position requires close attention to detail and focus on maximizing revenue for the Department and recommends process improvement initiatives as needed. He/she will maintain close communication with Departmental physicians, staff, and other Hospital members involved in the revenue cycle, as well as patients, referring physicians, and insurance companies to ensure the authorization cycle is followed and services are appropriately reimbursed. It is critical that the candidate possess strong professional communication, organizational (attention to detail), and teamwork skills to successfully perform in this role. Position will be asked to offer training to teammates, write up job policy and procedural guides, and lead process improvement efforts upon request.

- Associates Degree or demonstrated work experience in related field required; Bachelor's degree preferred.

- Three to five years of billing experience including revenue cycle preferred

- Background in healthcare administration required

- Knowledge of Medical Terminology is required

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:

- Excellent interpersonal skills and the ability to work well in a team environment.

- Excellent oral and written communication skills.

- Individual must be extremely organized, flexible, reliable, and independently motivated.

Technical Skills Required:

- Knowledge of practice operations and referral/authorization management standards.

- Understanding of Electronic Healthcare records (EPIC), faxing documents, adobe pdf, all MS applications

- Highly proficient in all communication skills (phone, verbal and written).

- Ability to handle sensitive information and situations with poise and professionalism.

Organization Skills:

- Strong organizational, coordination and judgment skills.

- Ability to prioritize effectively.

- Ability to manage multiple tasks effectively, following established protocols, and work within systems.

System Skills:

- Advanced computer skills.

- Ability to use all applicable applications at highest competency level.

- Ability to problem-solve and troubleshoot issues. Ability to analyze a situation and determine best course of action within established guidelines.

- Advanced understanding and use of medical terminology. - Advanced comprehension of billing and fiscal information.

- Knowledgeable and compliant with all hospital, State and Federal requirements (where applicable to job performance), including policy and procedures with The Joint Commission and HIPAA.

BWH is an Affirmative Action Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.