Key Facts

Remote From:

Full time

Junior (1-2 years)

English

Hard Skills

Prior Authorization CPT Coding Medical Abbreviations Account Management Escalation Procedures Care Management Data Consistency Computerized Physician Order Entry

Other Skills

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Professionalism
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Analytical Skills
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Multitasking
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Teamwork
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Verbal Communication Skills
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Social Skills

Roles & Responsibilities

High school graduate or equivalent; some college preferred.
1-2 years of insurance, third-party payor or secretarial experience in a health care setting.
Knowledge of medical terminology.
Strong analytical, communication, and interpersonal skills; ability to handle multiple duties.

Requirements:

Analyze and submit information for financial reimbursement to insurance providers prior to patient service.
Verify eligibility and authorization requirements with payors and physician offices; perform insurance verification via web or phone.
Create and verify all eligible coverages (electronic or manual), resolve discrepancies, and ensure coverages are assigned to the correct visit.
Collect and validate order-related information (office visits, radiology, surgical orders) and verify CPT codes with ordering providers.

Brigham and Women's Hospital

About Brigham and Women's Hospital

Boston's Brigham and Women's Hospital (BWH) is an international leader in virtually every area of medicine and has been the site of pioneering breakthroughs that have improved lives around the world. A major teaching hospital of Harvard Medical School, BWH has a legacy of excellence that continues to grow. With two outstanding hospitals, over 150 outpatient practices, and over 1,200 physicians, we serve patients from New England, throughout the United States, and from 120 countries around the world. The BWH name is a reflection of our history. In 1980 three of Boston’s oldest and most prestigious Harvard Medical School teaching hospitals - the Peter Bent Brigham Hospital, the Robert Breck Brigham Hospital, and the Boston Hospital for Women – merged to form Brigham and Women’s Hospital. As a national leader in improving health care quality and safety, we have helped to develop some of the industry’s best practices including computerized physician order entry (CPOE) to prevent medication errors. The CPOE is now a nationally-accepted safety practice. The BWH Biomedical Research Institute (BRI) is one of the most powerful biomedical research institutes in the world and the second largest recipient of National Institutes of Health (NIH) funding among independent hospitals in the United States. BWH has long had great success in research as measured by the number of important discoveries made, the size and scope of its research portfolio and the volume of publications annually. BWH is a training ground for physicians, nurses, and allied health professionals. We have 1,100 trainees in over 140 of the most sought after training programs in the world, and also host Harvard Medical School students in rotations throughout our programs. As our global health services expand, our clinical trainees have rich opportunities to contribute and learn in challenging environments around the world. Brigham and Women's Hospital is an EEO, AA, VEVRAA Employer.

Founded: 2018

Company size: 10001

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Job description

Site: Newton-Wellesley Hospital

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Under the direction of the Financial Coordinator Supervisor, ensures that all information necessary for proper financial reimbursement for high dollar patient care is analyzed and submitted to insurance companies for approval prior to the patient’s date of service. Collaborates with insurance companies and physician offices when necessary to verify eligibility and authorization requirements to ensure financial reimbursement for services.
Perform all insurance verification for eligibility, coverage, and authorization requirements via Web or phone with third party payers.
Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validates that coverages are assigned to appropriate visit. -Collects and validates order-related information including office visit, radiology and surgical orders. Follows up with ordering provider to verify CPT codes.
Escalates challenging accounts to team lead to ensure accounts are approved at prior to patient appointment/surgery. Escalates non-certified urgent cases to appropriate clinical departments and leadership for approval to proceed or communicate rescheduling.
Contacts providers and insurance companies to validate data, collect missing information and resolve information discrepancies, -Understands clinical guidelines for payors requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.
Work closely with physician offices obtaining authorization for inpatient and outpatient services
Work collaboratively with Case Management for all patients’ financial issues and updating accounts.

Qualifications

Education

High school graduate or equivalent; some college preferred

Experience

1-2 years of insurance, third party payor or secretarial experience in a health care setting required

Knowledge and Skills

Medical Terminology required
Analytical ability to gather and interpret data and communicate desired outcomes orally and in writing in a professional manner
Strong communication and interpersonal skills
Ability to handle multiple duties

Additional Job Details (if applicable)

Additional_Job_Description

Remote Type

Remote

Work Location

2014 Washington Street

Scheduled Weekly Hours

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$ - $25.28/Hourly

Grade

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

4100 Newton-Wellesley Hospital is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

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.

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