Team Lead Patient Access Representative

Mass General Brigham • Boston, MA

1d • Hybrid

About The Position

The Team Lead, under the direction of the Manager, is responsible for all the responsibilities of the Patient Business Representative positions. The PBR function as a financial counselor and registrar and is responsible for the in-depth evaluation of financial history for both uninsured and underinsured patients for determining eligibility for government and pharmacy financial assistance programs. The Team Lead will serve as the primary practice contact when patients require assistance with various billing/financial related issues, which cannot otherwise be resolved by the Practice Service Representative. The PBR Team Lead will have a strong working knowledge of all aspects of the billing/revenue cycle, managed care requirements, coding and compliance. Utilizing a variety of available resources and contacts the counselor will assess and work towards the resolution of identified patient fiscal issues. The PBR Team Lead will work collaboratively with BWPO Practice Management, Patient Accounts, BWH Customer Service, Patient Relations, BWPO Billing Agencies, the Office of General Counsel, and State Agencies, e.g., EOHHS, DHCFP, etc. In addition, the Patient Business Representative Team Lead will act as a Department resource, which may include assisting in the training of new hires, or the retraining of existing hires. The PBR Team Lead will act as lead for teams, as assigned, which can vary. The PBR Team Lead will assist the Management team in projects as necessary and assigned.

Requirements

• Bachelor’s degree or equivalent preferred; high school diploma required.
• Proven experience in like setting is acceptable in lieu of educational requirements.
• 3-5 years' experience in a hospital setting, experience with prior authorizations, billing and reimbursement helpful.
• Certified Applications Counselor (CAC)
• Familiarity with a hospital legacy system, Microsoft Office and Share Point preferred
• Prior experience with patient financial assistance or Government related programs preferred
• Knowledge of medical terminology helpful
• Bilingual preferred (Spanish)
• Interpersonal relationship skills necessary to communicate effectively with patient/family, physicians and their support staff, medical staff, nursing staff, other hospital personnel and many external organizations and agencies.
• The technical knowledge of specific legal and regulatory requirements and an understanding of complex third party and medical assistance policies and procedures.
• Knowledge of the hospital information system with emphasis on accounts receivables programs.
• Ability to function independently and prioritize work within established policies.
• Certified Applications Counselor (CAC)
• Requires good judgment, tact, sensitivity and the ability to function in a stressful environment.
• Ability to maintain confidentiality regarding the patients, their medical histories, demographic and fiscal information, etc.

Nice To Haves

• experience with prior authorizations, billing and reimbursement helpful.
• Familiarity with a hospital legacy system, Microsoft Office and Share Point preferred
• Prior experience with patient financial assistance or Government related programs preferred
• Knowledge of medical terminology helpful
• Bilingual preferred (Spanish)

Responsibilities

• Provide directions and guidance.
• Organizing tasks and setting goals.
• Training team members, setting strategy and monitoring performance progress towards goals.
• Collaborate with manage to discover training needs and assist with coaching.
• Assist with solving problems and resolving conflicts.
• Works projects related to the Inpatient Accounts Department when assigned.
• Assists in the review of staff denials when assigned.
• Acts as a subject matter expert for the department, and may be asked to participate in meetings, as necessary.
• Preform daily staff audits an assist with overseeing the day-to-day workflow operations.
• Work to create an inspiring team environment with an open communication culture.
• Interview patients in person and on the telephone in a professional manner that results in positive patient relations and prompt reimbursement for the hospital.
• Provide guidance, direction and assistance to patients.
• Verifies and/or collects demographic and financial information on all scheduled visits.
• Enters/edits data on-line as needed, ensuring its accuracy and integrity.
• Achieve and maintain mandatory ongoing department training and certification designation as Certified Application Counselor (CAC)
• Contacts insurance companies, managed care plans and outside agencies to verify insurance coverage and benefits.
• Respond to department email and phones call for request for services through the day.
• Document patient and request in FAM for tracking and follow up.
• Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net and Qualified Health Plans (QHP), assisting in the application process when appropriate.
• Submits applications all Massachusetts applicants for health coverage via the Health Connector online using the Assistor Portal, paper by fax or by phone when required.
• Maintains ongoing communication with government agencies regarding the status of claims, following up with patients as necessary to obtain required documentation to ensure that the state gets the info needed to process the applications in a timely matter.
• Keep track of all cases using FAM, paper tickle file system and keep a daily productivity log sheet when necessary.
• Acts as patient representative in any cases submitted via the Health Connector, paper or over the phone, assisting the patient in deciphering notices received from EOHHS.
• Assists patients in the redetermination process for MassHealth, Connector Care and or Health Safety Net.
• Assist with choosing a plan for Medicare Part D and Low-Income Subsidy for Medicare Part D.
• Assists in processing out of network Prior Authorizations, when needed.
• Assists patients in applying for and/or understanding all other financial assistance programs or low-cost insurance plans such as the Insurance Partnership, Medical Security Plan, and Health Connector Plans.
• Help patients apply for and or understand all other financial assistance programs such as INET’s Medical Hardship, Special Circumstances or the PHS Financial Assistance application.
• Submit and complete disability and long-term care Medicaid applications.
• Acts as a liaison between the patients, hospital billing department and BWPO practices/billing agencies in addressing any billing related inquires and issues.
• Create and provide estimates to patient, practice or insurance company.
• Accepts and/or arranges payment for deductibles and outstanding balances utilizing Chapter 224 Patient Estimations Policy and Procedure.
• Counsels and advises patients of discount options available according to Partners guidelines.
• Works to resolve collection disputes, collect payments from patients and post payments in EPIC Accounts Receivable System.
• Collect, Post and reconcile payment for services and secures cash drawer according to departmental procedures
• Re-bill accounts when necessary for the Hospital and BWPO.
• Directly interfaces with billing agencies in order to investigate patient reported issues and maintains a contact list.
• Utilizes knowledge of various payer requirements and when necessary researches any billing inquiries initiated by the patient and is able to provide a comprehensive and comprehendible explanation to the patient and or practice.
• Investigates MCO an ACO issues.
• Review visit notes/codes against what was entered in EPIC with RTE or another verification system to determine if an incorrect code was entered.
• Communicates with practice/physician to resolve problems regarding coding/billing issues.
• Fosters a positive relationship with assigned practice management, shares relevant findings, and enhances understanding of patient concerns.
• Enter billing issues in FAM for resolution.
• Works on special projects, cover other services and/or locations, and other task when necessary.
• Reviews and follows-up on all scheduled patient appointments within 24 hours at the latest, to identify and minimize financial risk to the institution.
• Maintains patient confidentiality and privacy by accessing patient information only to the extent necessary to fulfill assigned duties. All patient information must be kept private, confidential and secure. All lists, reports, files and documents must always be properly secured and stored. Interviews and examinations should be conducted in such a manner as to afford the patient reasonable audio and visual privacy.
• Maintains effective working relationships and communicates regularly with providers and other departments to update and exchange pertinent account information.
• Adheres to Customer Service Standards by demonstrating professionalism, alertness, helpfulness, and receptiveness to all patients, visitors and other staff members.
• Employs discretion when leaving answering machine messages or sending faxes.
• Supports team manager and performs management duties when manager is absent or out of office.
• Assists management with hiring processes and new team member training.
• Assist management with weekly and monthly progress reporting, tracking progress, monitoring team members' tasks, and ensuring deadlines are met also are functions of a team leader.
• Answers team member questions, helps with team member problems, and oversees team member work for quality and guideline compliance.
• Assists with the new patient registration in Epic.

Benefits

• Medical, Dental, and Vision insurance
• Tuition Reimbursement
• Generous Paid Time Off
• 50% Off MBTA passes
• Access to childcare resources and emergency backup care
• 403(b), Cash Balance Retirement Plan, and Tax-Sheltered Annuity options
• Exclusive “Perks” - enjoy discounts on tickets and passes for everything from ski resorts to museums to sporting events

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED