The Clinical Revenue Coordinator is responsible for front-end revenue cycle processes, as well as assisting with workqueue management for the Department of Neurosurgery Billing and Revenue Cycle Team. The Clinical Revenue Coordinator is responsible for ensuring all neurosurgical patients have verified insurance and proper authorizations for outpatient visits and surgical procedures. This position requires close attention to detail, and will work very closely with the managed care teams at BWH & BWFH, South Shore Hospital and Milford Regional Medical Center, as well as the administrative personnel within the Department of Neurosurgery. The Coordinator must be autonomous and enjoy working as part of a team. The Coordinator must also initiate frequent communication with insurance companies, physicians, and staff members to ensure the smooth operation of departmental and clinical needs.
Brigham and Women’s Hospital is dedicated to:
- serving the needs of our local and global community
- providing the highest quality health care to patients and their families
- expanding the boundaries of medicine through research
- educating the next generation of health care professional
Every employee plays an important role in providing a positive impact on the organization and the people we serve. Your work will be distinguished by demonstrating respect and dignity in all interactions with patients, families and colleagues, excellence in customer service and job performance.
All employees are expected to embrace this commitment and demonstrate behavioral competencies in the following areas:
People: Focus on serving the community through collaboration and respect
Self Management: Accountability, professionalism and commitment to growth and development
Organization: A commitment to quality, service and exceptional performance
Meeting these expectations is key to the success of your department and the organization.
This job description includes:
- General expectations for the position
- Addendum A – BWH Behavioral Competencies
- Addendum B-Job Specific Tasks and Responsibilities
- Addendum C – Physical/Working Conditions
PRINCIPAL DUTIES AND RESPONSIBILITIES:
· See Addendum B
· Provides direct support to the finance team.
· Performs duties under minimal supervision at the highest proficiency level.
· Ability to problem solve and determine best course of action with little direction.
· Prioritizes workflows and troubleshoots issues
· Takes initiative using all available resources, follows through on issues when needed, applies knowledge as appropriate with little direction from Supervisor.
· Tracks and analyzes project and productivity data, including maintenance and creation of databases.
· Assists with training and orienting staff as needed.
· Provide cross-coverage as needed.
· Follows HIPAA guidelines for the management of patient privacy and confidentiality.
· Other duties, as assigned.
Level of education required:
- Bachelor’s degree required or appropriate level of work experience
- Two to three years experience in a busy academic medical center a plus
- Knowledge of Medical Terminology is preferred
- Experience of surgical scheduling is preferred
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, and independently motivated.
Technical Skills Required:
- Knowledge of practice operations and standards.
- Understanding of procedures including filing, copying, scanning, printing, and faxing.
- 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 highest competency level.
- Ability to problem-solve and troubleshoots. 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.
- See Addendum A
Responsible for economical use of resources and time.
ADDENDUM – A: BWH BEHAVIORAL COMPETENCIES
1. People: Focus on serving the community through collaboration and respect
Definition: Maintain an environment where individuals value and respect differences in all situations. Stand firm against intolerance and bias to create a welcoming environment and respect all individuals regardless of race, gender identity, ethnicity, language, sexual orientation, age, physical or mental ability, religion, socio-economic status, or national origin.
- Work effectively with others who have diverse perspectives, talents, roles, backgrounds and/or styles
- Contribute to a positive team environment where differences are respected, supported and are free from stereotyping and offensive comments
- Be professional when approached about behaviors that might be perceived as disrespectful
Definition: The ability to effectively articulate and receive information in a clear, concise and timely manner.
- Practice active listening skills
- Foster and maintain an environment that respects open dialogue, differences of opinion, as well as diverse communication styles
- Ensure that information is shared in a clear, accurate, and timely manner using the appropriate communication method for your audience
- Express oneself clearly and professionally in your verbal, non-verbal, written, and electronic communication
Building Collaborative Relationships
Definition: Identifying opportunities and taking action to build relationships between one’s area and other areas, teams, departments, units, or organizations to help achieve organizational goals.
- Take initiative to support others and build productive relationships that will lead to a cohesive workplace
- Interact effectively with other team members, departments and customers to accomplish organizational goals
Definition: Understand how one’s own work affects the organization as a whole and demonstrate a commitment to the organizational goals.
- Support and respect BWH’s mission, vision, values and history
- Understand and recognize how your individual role and department impacts the organization
2. Self-Management: Accountability, professionalism and commitment to growth and development
Definition: Demonstrate adaptability and openness to organizational changes needed to improve effectiveness and goals.
- Support and positively participate in organizational and/or job specific changes
- Initiate appropriate action when change is needed
- Be flexible and open to new ideas
- Adapt to shifting priorities
Definition: Predisposed to pursue learning opportunities even outside own comfort zone, one stays abreast of new tools and methods, rising to add value and build challenge in current assignments.
- Demonstrate openness to learning from successes and failures
- Recognize and participate in learning opportunities
- Seek and share best practices
Definition: Practice respect for self and others; and adhere to BWH standards, policies, and procedures at all times.
- Adhere to BWH’s Code of Conduct, Guide to Ethical Standards, policies and procedures
- Align behavior with the organizational mission and values
- Practice respect in accordance to the BWH standards
- Demonstrate responsibility, reliability, and trustworthiness
3. Organization: A commitment to quality, service and exceptional performance
Quality and Safety Focus
Definition: Responsible for meeting standards of performance or outcomes in a safe manner while avoiding risks.
- Align job performance with quality and safety standards (e.g. The Joint Commission, BWH and department specific standards)
- Adhere to established policies and procedures
- Take action to prevent errors
- Identify and report adverse events, errors and incidents
Efficiency and Performance Improvement
Definition: Systematic approach to improve performance by eliminating waste, non-value added activities and variability in processes.
- Participate in process and performance improvement by identifying, analyzing, and enhancing existing processes to achieve better outcomes
- Maximize available resources to achieve performance measures; reduce waste, rework, and work-arounds consistent with one’s role
Definition: Able to gather appropriate data and diagnose the cause of the problem before taking action; and if necessary develop alternative courses of action.
- Recognize actual and potential problems and take appropriate action towards a solution
- Offer assistance, as needed, when a potential problem situation is observed
- Use good judgment to keep manager informed of problems or issues, following department practice
Definition: Focusing one’s efforts towards anticipating, meeting and exceeding the expressed and unexpressed needs or expectations of internal and external customers.
1. Apply service standards consistently to present a positive image of BWH to colleagues, health providers, patients, families, and visitors:
2. Engage with positive greetings and active listening
3. Empathize by expressing understanding
4. Educate throughout the information exchange
5. Enlist thoughts and ideas from others
4. General/Administrative Support: (required of all Administrative Support employees)
Definition: Identify and seek information needed to clarify a situation. Ask questions to discover the facts.
- Identify specific information needed to clarify a situation or to make a decision
- Probe skillfully to get at the facts
ADDENDUM – B: JOB SPECIFIC TASKS AND RESPONSBILITIES
1. The Coordinator is responsible for supporting the Billing and Revenue Cycle.
2. Responsible for ensuring all neurosurgical patients have verified insurance and proper authorizations for outpatient visits and surgical procedures. Any delay or error in the front-end process will cause insurance denials and disrupt cash flow.
3. The Coordinator’s work is essential to ensure authorizations are in place to maximize reimbursement for the successful operation of the department. Open communication and review of pending authorizations with the Billing and Revenue Cycle team is expected to ensure all appropriate action has been taken.
4. Works closely with patient registration, third-party carriers and BWH Admitting to ensure correct patient demographic and insurance information is present in BWH scheduling systems (Epic)
5. Obtain referrals, pre-certifications and authorizations as needed by working collaboratively with the Billing Manager, Administrative Assistants, Physicians, and third-party insurance carriers for clinical and surgical patients
6. Reviews upcoming clinic and surgical schedule and alerts appropriate personnel if issues exist
7. Responsible for daily clinic prep in which co-pay amounts and referrals are noted for each patient at least a day in advance. Maintains referral spreadsheet and updates as appropriate
8. Develop and streamline referrals process to reduce claim denials to improve cash flow related to back end revenue cycle
9. Responsible for daily management of Epic workqueues to ensure queues are being worked in a timely.
10. Responsible for daily management of surgical tracking spreadsheet by monitoring and tracking scheduled cases to determine and ensure eligibility and authorizations are in place before service is rendered at all locations where surgery is being performed (main campus and satellite offices).
11. Manages the Epic workqueue process for outpatient E&M billing by checking that notes are signed within the defined time period and entered accurately.
12. Ensures all activity is accounted for and billed by running OR schedules at month-end and reconciling any discrepancies.
13. Attend monthly billing meeting with outside vendor to understand trends and challenges.
14. Act as BWH Neurosurgery billing liaison for satellites and other hospitals where BWH Neurosurgery is performing services.
15. The Coordinator facilitates process improvement as needed in collaboration with billing and operational teams and does so independently and without supervisory responsibility over team members.
16. Ability to identify and synthesize issues, develop solutions, and communicate next steps to appropriate parties.
17. May be responsible for presentation development and display within and outside of the Department of Neurosurgery, including presentations for new/current staff.
18. Responsible for backing up other team members within the Billing and Revenue Cycle team, to ensure appropriate practice coverage for the division.
19. Responsible for answering telephones as necessary (handling, routing, and/or taking messages), as well as maintaining organized and prompt email communication. Responsible for timely and appropriate distribution of messages and information. May require sensitive handling of patient and physician calls.
20. The Coordinator will act professionally and appropriately to resolve all concerns whenever possible and will seek council from departmental leadership when appropriate and necessary.
21. Maintain effective and harmonious working relationships with co-workers, faculty, and other department members to promote a culture of wellness and a culture of excellence for the division and department.
22. All duties handled with attention to detail and urgency.
23. Manages additional duties, as requested or required.
24. Performs all other duties as assigned by the Finance Manager, Billing Manager, and/or Executive Director.
Brigham and Women’s Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, ancestry, age, veteran status, disability unrelated to job requirements, genetic information, military service, or other protected status.