Lead Prior Authorization Coordinator, Clinical Neurology at Partner's Healthcare in Boston, Massachusetts

Job Description:

Site: The Brigham and Women's Hospital, Inc.


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
Under the direction of the Finance Director and in coordination with the Practice Administrator, the Lead Prior Authorization Coordinator is responsible for supporting the front and back-end revenue cycle processes for the Department of Neurology. 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. The candidate must possess strong professional communication, organizational (attention to detail), and teamwork skills to successfully perform in this role. The position will be asked to offer training to teammates, write up job policy and procedural guides, and lead process improvement efforts upon request.



Qualifications

• 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, and 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).


• Share information with MCC staff to enhance department efficiency/performance.


• Assists Practice Administrator (PA) with the Development of standardized approaches for operational issues, reporting, analysis, and quality management.


• Reviews key measures regularly and develops new measures as needed.


• Develops expertise in querying systems for data and reports.


• Works closely on interface and system issues as required to improve data flow.


• Monitors practice activity utilizing the EPIC Dashboard and workbench reports.


• Ensures that denials are worked in 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.


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


• Ascertain work-related visits and cases; obtain all necessary worker compensation information to initiate and complete negotiations and billing. • Complete the referral management process in conjunction with the 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.


• 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 the 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 the 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 procedural care promptly.


• 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).


• Works the missing referral/authorization denial work queue to find resolutions to payment discrepancies and coordinates with the billing team to conduct appeals.


• Maintains close communication with the practice management team and the Department's professional billing staff to re-process claims promptly.


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


• Performs all other duties as assigned.

Qualifications:

• Associate degree or demonstrated work experience in a 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.


• 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.


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


• Understanding of Electronic Healthcare records (EPIC), faxing documents, Adobe PDF, and all MS applications


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


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


• Strong organizational, coordination, and judgment skills.


• Ability to prioritize effectively.


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


• Advanced computer skills.


• Ability to use all applicable applications at the highest competency level.


• Ability to problem-solve and troubleshoot issues.


• Ability to analyze a situation and determine the 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.

Additional Job Details (if applicable)


Additional Job Description



Remote Type


Onsite



Work Location


75 Francis Street



Scheduled Weekly Hours


40



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


The Brigham and Women's Hospital, Inc. 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.



Mass General Brigham Competency Framework


At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply Now