Per-Diem Billing Associate/Managed Care Coordinator - Ortho_BIDMC_

Boston

**Job Type:** Per Diem

**Time Type:** Part time

**Work Shift:** Day (United States of America)

**FLSA Status:** Non-Exempt

**When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.**

Uses systems and billing knowledge to assist in all aspects of professional and facility billing on the front end, such as patient billing disputes and capturing missing registration information. Creates Self-Pay and Estimate Letters where requested, working with coders, administration and physicians, gathering relevant billing information. Works all pre-billing edits defined by TES. Assists in high-cost drug prior authorization capture process. Assists professional billing service with back-end billing issues, such as COB denials, reaching out to patients requesting specific information to assist with continuing claims processing. Works collaboratively with primary care or specialty physicians, their patients and practices to coordinate and process managed care referrals and / or authorizations for patient care services, complying with BIDCO's and BIDMC's contractual rules for multiple managed care insurance payers.

**Job Description:**

**Essential Responsibilities:**

1. Investigates patient billing disputes, listens attentively to patient concerns, works with coders requesting coding documentation review to determine correct code(s) selection, provides patient with final review outcome making necessary changes when errors determined.

2. Provides Self Pay Estimates to patients for office visits and collects payments in advance for appropriate clinic sites and for surgical procedures, including Cosmetics, and collects payments in advance where appropriate. Notifies billing agent of collected payments for appropriate payment crediting.

3. Maintains Estimates and Collection Receipts in the Orthopedic Billing Shared Drive. As a courtesy, will provide facility charges to the patient received from BIDMC.

4. Runs and works the missing elements reports, verifying accuracy of registered payer information (workers compensation, auto liability), providing updated information, where appropriate, within registration and outreaching to patients to obtain necessary missing information.

5. Works TES edits and identifies trends in errors, correcting registration errors and providing missing billing information where required by payer for a smoother charge capture flow through the revenue cycle. Adds all off-site surgical cases to each provider's E-Ticket Patient Census to assist in easier charge capture for the practice.

6. Responsible for prior authorization capture for high-cost drugs when requested. Duties include partial completion of payer prior authorization forms, faxing completed PA forms and all necessary clinical documentation to the payer for review, records prior authorization #, when received, into the referral management system, notifies administrative schedulers and the provider of approval or denial.

7. Works BIDMC Missing Elements Report daily obtaining missing demographic/insurance information and updating registration with accurate information by reaching out to patients where needed relative to pending and/or denied claims.

8. Assists in capturing all missing auto insurance information when needed. Updates Registration with auto liability information and notifies coders of update. Assists billing agency with COB claims issues, reaching out to patients obtaining additional information and/or providing patient instructions.

9. Provides Insurance Estimate Letters, utilizing payer website cost estimator when available and/or appropriate CPT codes with instructions to contact Member Services for additional assistance.

10. Collaborates with referring physicians, patients and support staff to request, obtain, record, and attach primary and/or specialty care managed care referral and authorization requests for multiple managed care insurance payers for a high volume of patients.

11. Utilizes electronic technologies to initiate, request, and procure a high volume of referral and authorizations for multiple managed care payers.

12. Educates patients about the referral process, programs offered, and services provided at BIDMC and affiliated Care Group institutions. Communicates to the provider and/or patient the level of care, number of visits being authorized.

13. Communicates with managed care payers to resolve patient referral management issues. As appropriate, coordinates referrals with hospital's discharge planner and registration and pre-certification admitting department as required by the insurance company.

14. Provides referral management training and oversight to department new hires. Contributes as a managed care resource for everyone on the unit including all patients, physicians, social workers, nurses, practice assistants, and support staff.

15. Runs daily, weekly, and monthly statistical referral management and booking reports; enters data obtained from the reports into Excel spreadsheets.

16. Coordinates daily with the Referral Specialist and the support staff team in the running of the referral management reports and enters information daily; collaborates on negative indicators to improve referral management outcomes.

17. All other task as assigned

Required Qualifications:

18. High School diploma or GED required. Associate's degree preferred.

19. 3-5 years related work experience required.

20. Knowledge of health care revenue cycle, including billing and reimbursement

21. Advanced skills with Microsoft applications which may include Outlook, Word, and Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Competencies:

22. Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.

23. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.

24. Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.

25. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.

26. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.

27. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.

28. Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.

29. Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

Physical Nature of the Job:

Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally

Additional Job Description

**As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (ilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.**

**More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.**

**Equal Opportunity** **Employer/Veterans/Disabled**